Healthcare Provider Details

I. General information

NPI: 1477243244
Provider Name (Legal Business Name): ELENA ANDRONOVA DMD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2023
Last Update Date: 05/15/2023
Certification Date: 05/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5701 NE BOTHELL WAY STE 1
KENMORE WA
98028-9400
US

IV. Provider business mailing address

5701 NE BOTHELL WAY STE 1
KENMORE WA
98028-9400
US

V. Phone/Fax

Practice location:
  • Phone: 425-488-9785
  • Fax:
Mailing address:
  • Phone: 425-488-9785
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. ELENA ANDRONOVA
Title or Position: OWNER
Credential:
Phone: 703-388-8844