Provider Demographics
NPI:1477243244
Name:ELENA ANDRONOVA DMD PLLC
Entity Type:Organization
Organization Name:ELENA ANDRONOVA DMD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ELENA
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDRONOVA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-388-8844
Mailing Address - Street 1:5701 NE BOTHELL WAY STE 1
Mailing Address - Street 2:
Mailing Address - City:KENMORE
Mailing Address - State:WA
Mailing Address - Zip Code:98028-9400
Mailing Address - Country:US
Mailing Address - Phone:425-488-9785
Mailing Address - Fax:
Practice Address - Street 1:5701 NE BOTHELL WAY STE 1
Practice Address - Street 2:
Practice Address - City:KENMORE
Practice Address - State:WA
Practice Address - Zip Code:98028-9400
Practice Address - Country:US
Practice Address - Phone:425-488-9785
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-15
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental