Healthcare Provider Details

I. General information

NPI: 1417091943
Provider Name (Legal Business Name): ILYA MILOSLAVSKIY D.D.S
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/17/2007
Last Update Date: 06/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1130 140TH AVE NE STE 100B
BELLEVUE WA
98005
US

IV. Provider business mailing address

313 AVENUE OF THE AMERICAS APT. 1A
NEW YORK NY
10014-4445
US

V. Phone/Fax

Practice location:
  • Phone: 425-746-6090
  • Fax: 425-747-9856
Mailing address:
  • Phone: 917-658-4575
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number60452580
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number052222
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: