MEDICARE: INNA BUDIYANSKAYA D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	052425	NY
2	122300000X	Dentist	22DI02323600	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1972787059
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	INNA BUDIYANSKAYA D.D.S.

Provider Business Mailing Address
First Line	:	1208 FLATBUSH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11226-7005
Country	:	US
Telephone Number	:	718-282-8066
Fax Number	:	718-282-8003

Provider Business Practice Location Address
First Line	:	1208 FLATBUSH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11226-7005
Country	:	US
Telephone Number	:	718-282-8066
Fax Number	:	718-282-8003

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/25/2007
Last Update Date	:	12/25/2007

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