Vyacheslav Dmytruk, D.M.D

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D11399 Issued in OR

Practice address

1729 W Harvard Ave Ste 2
Roseburg, OR 97471-2795

Phone

(458) 802-7028

Fax

(541) 516-4345

NPI assigned

Dec 1, 2014

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1417392000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1612137600000",
    "number": "1356748784",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1729 W HARVARD AVE STE 2",
            "city": "ROSEBURG",
            "state": "OR",
            "postal_code": "974712795",
            "telephone_number": "458-802-7028",
            "fax_number": "541-516-4345"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1729 W HARVARD AVE STE 2",
            "city": "ROSEBURG",
            "state": "OR",
            "postal_code": "974712795",
            "telephone_number": "458-802-7028",
            "fax_number": "541-516-4345"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "185 Main St",
            "address_purpose": "LOCATION",
            "city": "Waterville",
            "state": "ME",
            "postal_code": "049016625",
            "country_code": "US",
            "telephone_number": "207-872-6815",
            "fax_number": "207-872-6888",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DMYTRUK",
        "first_name": "VYACHESLAV",
        "name_prefix": "Dr.",
        "credential": "D.M.D",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2014-12-01",
        "last_updated": "2021-02-01",
        "certification_date": "2021-02-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "OR",
            "license": "D11399",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "ME",
            "license": "DEN4408",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "OR",
            "license": "D11399",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Roberta A. Diemer, PH.D.
• James Diemert, OTR
• Scott David Dietrich, BSW
• Lillyanne Dileo
• Lisa Dawn Disante, BSN, RN, BC
• Thu Mi DO, PHARMD
• Jane Lynn Docken, LPC
• Megan Dodge
• Rumen Doggett
• Derya Dolan, AMFT

• General Practice Dentistry in Roseburg, OR
• Providers in Roseburg, OR by specialty
• General Practice Dentistry in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 1, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.