Provider Demographics
NPI:1639622095
Name:DR GALINA BORODYANSKY PLLC
Entity Type:Organization
Organization Name:DR GALINA BORODYANSKY PLLC
Other - Org Name:BEL-MOD DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GALINA
Authorized Official - Middle Name:
Authorized Official - Last Name:BORODYANSKY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:425-644-8787
Mailing Address - Street 1:14535 BEL RED RD STE 101B
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98007-3907
Mailing Address - Country:US
Mailing Address - Phone:425-644-8787
Mailing Address - Fax:425-641-8203
Practice Address - Street 1:14535 BEL RED RD STE 101B
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98007-3907
Practice Address - Country:US
Practice Address - Phone:425-644-8787
Practice Address - Fax:425-641-8203
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-02
Last Update Date:2016-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA9423122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty