Healthcare Provider Details

I. General information

NPI: 1669246864
Provider Name (Legal Business Name): ANYA V BOINIK DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: GANNA VADIMIVNA BOINIK

II. Dates (important events)

Enumeration Date: 11/08/2023
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 N 12TH ST
RICHMOND VA
23298-5064
US

IV. Provider business mailing address

PO BOX 980566
RICHMOND VA
23298-0566
US

V. Phone/Fax

Practice location:
  • Phone: 804-828-9363
  • Fax: 804-827-0736
Mailing address:
  • Phone: 804-828-9363
  • Fax: 804-827-0736

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number0401419907
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: