Pavel Tereshchuk

Primary specialty

Dental HygienistTaxonomy code 124Q00000X

License

DH61098804 Issued in WA

Practice address

4111 Alderwood Mall Blvd
Lynnwood, WA 98036-6765

Phone

(425) 249-0771

NPI assigned

Aug 12, 2021

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1628726400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1629417600000",
    "number": "1992470827",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10829 87TH AVE NE",
            "city": "MARYSVILLE",
            "state": "WA",
            "postal_code": "982717629"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4111 ALDERWOOD MALL BLVD",
            "city": "LYNNWOOD",
            "state": "WA",
            "postal_code": "980366765",
            "telephone_number": "425-249-0771"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TERESHCHUK",
        "first_name": "PAVEL",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-08-12",
        "last_updated": "2021-08-20",
        "certification_date": "2021-08-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "124Q00000X",
            "taxonomy_group": "",
            "desc": "Dental Hygienist",
            "state": "WA",
            "license": "DH61098804",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "4259772580",
            "affiliation": "N",
            "address_1": "4111 Alderwood Mall Blvd",
            "city": "Lynnwood",
            "state": "WA",
            "country_code": "US",
            "postal_code": "980366765",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Stephanie Taylor, DDS
• Vanessa Renee Taylor
• Biruke Tekelegiorgis
• Cynthia Tembula, PHARMACY TECHNICIAN
• Valery L Teran
• Andrea I Terrazas
• Yordanos Tsehaye Tesfai, RN
• Kassahun M Tessema
• Diwakar Thapa, PHARM D.
• The Bartell Drug Co

• Dental Hygienist in Lynnwood, WA
• Providers in Lynnwood, WA by specialty
• Dental Hygienist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 20, 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.