Active NPI
Ruslan Semchyshyn
- General Practice Dentistry
- Dawsonville, GA
National Provider Identifier
1386174126
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- DN015449
- Practice address
- 671 Lumpkin Campground Rd S Ste 110
Dawsonville, GA 30534-0931 - Phone
- (706) 265-0070
- Fax
- (706) 265-0072
- NPI assigned
- Jun 14, 2017
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | DN015449 | GA | Primary |
Addresses
Primary practice location
671 Lumpkin Campground Rd S Ste 110
Dawsonville, GA 30534-0931
Mailing address
3590 Regency Park Dr
Duluth, GA 30096-3818
Phone (770) 789-0989
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in GA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20171205002114 | GA | Order and Referring Only - Dentist | 1759648421 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DN015449 | GA | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1497398400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1497398400000",
"number": "1386174126",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3590 REGENCY PARK DR",
"city": "DULUTH",
"state": "GA",
"postal_code": "300963818",
"telephone_number": "770-789-0989"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "671 LUMPKIN CAMPGROUND RD S STE 110",
"city": "DAWSONVILLE",
"state": "GA",
"postal_code": "305340931",
"telephone_number": "706-265-0070",
"fax_number": "706-265-0072"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SEMCHYSHYN",
"first_name": "RUSLAN",
"name_prefix": "Dr.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2017-06-14",
"last_updated": "2017-06-14",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "GA",
"license": "DN015449",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Dawsonville, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 14, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.