DR. DMITRY PEYSAKHOV (NPI# 1477718229) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1477718229 |
| Entity Type | Individual |
| Full Name | DR. DMITRY PEYSAKHOV |
| Credential | D.M.D. |
| Practice Address |
1416 Highlands Dr Ne Suite 120 Issaquah WA 98029-6240 |
| Mailing Address |
4047 258th Way Se Issaquah WA 98029-7763 |
| Practice Telephone | 7818568080 |
| Mailing Telephone | 7818568080 |
| Enumeration Date | 2008-07-22 |
| Last Update Date | 2015-09-02 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223S0112X |
Dentist Specialization: Oral and Maxillofacial Surgery |
DE 60498667 | WA | Dental Providers |
| N | 1223S0112X |
Dentist Specialization: Oral and Maxillofacial Surgery |
DS038644 | PA | Dental Providers |
| Street Address |
1416 HIGHLANDS DR NE SUITE 120 |
| City | ISSAQUAH |
| State | WA |
| Zip Code | 98029-6240 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962824243 | Washington Dental Corporation, PC | Dentist | 1416 Highlands Dr Ne, Suite 120, Issaquah, WA 98029-6240 | 2014-01-06 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134730161 | Katelyn Creech | Counselor | 1505 16th Lane Ne, Apt 404 Building O, Issaquah, WA 98029 | 2020-08-13 |
| 1326695438 | M Shoaib Haider Siddiqui | Dentist | Issaquah Modern Dentistry, 1416 Highlands Drie Ne, Suite 120, Issaquah, WA 98029 | 2019-08-22 |
| 1053885061 | Rose Osborne | Registered Nurse | 4580 Klahanie Dr Se #181, Sammamish, WA 98029 | 2019-01-14 |
| 1598260960 | Caryn Crosbie | Behavior Technician | 22526 Se 64th Place, Building D Suite 210, Issaquah, WA 98029 | 2018-03-28 |
| 1194110908 | May Y. Mar | Family Medicine | 5708 E. Lake Sammamish Pkwy Se, Issaquah, WA 98029 | 2015-03-30 |
| 1659765816 | Eastside Social Skills Therapy LLC | Preferred Provider Organization | 5436 232nd Ave Se, Issaquah, WA 98029 | 2015-03-26 |
| 1649513946 | Linda Scoppettone Knodel | Registered Nurse | 5303 231 Ave. Se, Issaquah, WA 98029 | 2013-04-04 |
| 1720323116 | Morley Slutsky | Preventive Medicine | 4580 Klahanie Dr. S.e.,#125, Issaquah, WA 98029 | 2012-12-11 |
| 1619248820 | Silas Dickenson Dudley | Dentist | 2520 Ne Park Dr, Suite C, Issaquah, WA 98029 | 2012-01-19 |
| 1659641678 | Cynthia J Creel | Technician/Technologist | 4580 Klahanie Dr. Se, #332, Issaquah, WA 98029 | 2012-01-06 |
| Find all providers in zip 98029 | ||||
| Taxonomy Code | 1223S0112X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Oral and Maxillofacial Surgery |
| The specialty of dentistry which includes the diagnosis, surgical and adjunctive treatment of diseases, injuries and defects involving both the functional and esthetic aspects of the hard and soft tissues of the oral and maxillofacial region. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1811163611 | Hardeep Dhaliwal | Dentist | 6505 226th Pl Se Ste 100, Issaquah, WA 98027-8905 | 2008-05-01 |
| 1447461173 | Ju Yon Sophie Yi | Dentist | 450 Nw Gilman Blvd Ste 101, Issaquah, WA 98027-2483 | 2007-05-24 |
| 1083148308 | Northwest Maxillofacial and Cosmetic Surgery Associates Ps | Dentist | 6505 226th Pl Se Ste 100, Issaquah, WA 98027-8905 | 2017-04-13 |
| 1043421365 | Craig Peter Johnston | Dentist | 22619 Se 64th Pl, Suite 110, Issaquah, WA 98027-5342 | 2007-05-25 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1023619657 | Washington Jaw and Facial Surgery Pllc | Dentist | 451 Duvall Ave Ne Ste 100, Renton, WA 98059-4675 | 2020-11-02 |
| 1952909145 | Calley Christie Dmd Pllc | Dentist | 275 Sw 160th St Ste 115, Burien, WA 98166-3003 | 2020-10-11 |
| 1679197016 | Tae Youn Dds Md Pllc | Dentist | 15808 Mill Creek Blvd Ste 202, Mill Creek, WA 98012-1500 | 2020-06-02 |
| 1417416728 | Sam Wise | Dentist | 1538 11th Ave Lowr Columbia, Longview, WA 98632 | 2019-03-16 |
| 1740744374 | Thompson Ferguson Schrack Pllc | Dentist | 7604 Ne 5th Ave Ste 114, Vancouver, WA 98665-8200 | 2019-01-28 |
| 1053875096 | John K Tidwell Dds and Elizabeth A Kutcipal Dds Pllc | Dentist | 1801 Nw Market St Ste 108, Seattle, WA 98107-3909 | 2019-01-23 |
| 1255803904 | Edwards, Johnson, Johnson & Johnson D.d.s., P.l.l.c. | Dentist | 601 S Carr Rd Ste 300, Renton, WA 98055-5840 | 2018-12-19 |
| 1104396969 | Mark Stivers, Dds, Inc., P.s. | Dentist | 12728 19th Ave Se Ste 101, Everett, WA 98208-6526 | 2018-12-04 |
| 1144797499 | Washington Jaw and Facial Surgery Pllc | Dentist | 1370 116th Ave Ne Ste 101, Bellevue, WA 98004-3825 | 2018-10-25 |
| 1780151027 | Washington Jaw and Facial Surgery Pllc | Dentist | 2111 N Northgate Way Ste 105, Seattle, WA 98133-9018 | 2018-10-25 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.