Vasyl Leskiv
Individual provider Active NPI General Practice Dentistry · Lorena, TX
NPI 1043622673 · NPPES record last updated Jun 2, 2014
Key facts
- NPI
- 1043622673
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- 0401414295 (VA)
- Practice address
- 117 Village Place Dr
Lorena, TX 76655-9730 - Phone
- (973) 870-9727
- NPI assigned
- Jun 2, 2014
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
- Opted out of Medicare
- Yes, effective Mar 8, 2021 through Mar 8, 2027
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0401414295 | VA | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Giovanni P. Iuculano DDS PC | General Practice | Past | Accepting new patients |
| Giovanni P. Iuculano, DDS., PC | General Practice | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 0401414295 | VA | Yes |
Addresses
Primary practice location
117 Village Place Dr
Lorena, TX 76655-9730
Mailing address
117 Village Place Dr
Lorena, TX 76655-9730
Phone (973) 870-9727
Other providers in Lorena, TX
- James David Huffman
- Caroline Grace Jarvis
- Shawna Marie Johnston
- Jan Marie Lamar
- Lori Renae Laskoskie
- Morgan Lynn Long
- Antonia D Lopez
- Lorena Isd
- Brett Alan Marvel
- Nathan Andrew Matlack
All providers in Lorena, TX · General Practice Dentistry in Texas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 2, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Opt Out Affidavits (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.