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General NPI Number Information
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NPI Number | 1720726821
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Entity Type | Individual
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Provider Name | YULIA ANNENKOVA DMD
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Gender | Female
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Dates
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Enumeration Date | 05/27/2022
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Last Update Date | 03/30/2025
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Provider Practice Location Address
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Address Line | 9733 BUSTLETON AVE
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City | PHILADELPHIA
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State | PA
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Zip | 19115-3231
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Country | US
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Telephone | 215-774-5050
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Fax |
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Provider Business Mailing Address
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Address Line | 1801 WINCHESTER AVE APT B8
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City | PHILADELPHIA
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State | PA
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Zip | 19115-4647
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Country | US
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Telephone | 619-753-7604
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DS043865
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License Number State | PA
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