Provider Demographics
NPI:1609935857
Name:BAGDASAROV, YURIY VLADIMIROVICH (DDS)
Entity Type:Individual
Prefix:DR
First Name:YURIY
Middle Name:VLADIMIROVICH
Last Name:BAGDASAROV
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:909 SE EVERETT MALL WAY
Mailing Address - Street 2:B 250
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98208-3746
Mailing Address - Country:US
Mailing Address - Phone:425-355-0600
Mailing Address - Fax:425-348-4297
Practice Address - Street 1:909 SE EVERETT MALL WAY
Practice Address - Street 2:B 250
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98208-3746
Practice Address - Country:US
Practice Address - Phone:425-355-0600
Practice Address - Fax:425-348-4297
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2013-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE00008641122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist