Provider Demographics
NPI:1043622673
Name:LESKIV, VASYL
Entity type:Individual
Prefix:
First Name:VASYL
Middle Name:
Last Name:LESKIV
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 VILLAGE PLACE DR
Mailing Address - Street 2:
Mailing Address - City:LORENA
Mailing Address - State:TX
Mailing Address - Zip Code:76655-9730
Mailing Address - Country:US
Mailing Address - Phone:973-870-9727
Mailing Address - Fax:
Practice Address - Street 1:117 VILLAGE PLACE DR
Practice Address - Street 2:
Practice Address - City:LORENA
Practice Address - State:TX
Practice Address - Zip Code:76655-9730
Practice Address - Country:US
Practice Address - Phone:973-870-9727
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-02
Last Update Date:2014-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014142951223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice