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General NPI Number Information
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NPI Number | 1417091943
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Entity Type | Individual
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Provider Name | ILYA MILOSLAVSKIY D.D.S
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Gender | Male
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Dates
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Enumeration Date | 02/17/2007
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Last Update Date | 06/07/2018
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Provider Practice Location Address
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Address Line | 1130 140TH AVE NE STE 100B
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City | BELLEVUE
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State | WA
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Zip | 98005
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Country | US
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Telephone | 425-746-6090
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Fax | 425-747-9856
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Provider Business Mailing Address
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Address Line | 313 AVENUE OF THE AMERICAS APT. 1A
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City | NEW YORK
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State | NY
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Zip | 10014-4445
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Country | US
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Telephone | 917-658-4575
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0700X
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Taxonomy Name | Prosthodontics
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License Number | 60452580
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 052222
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License Number State | NY
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