Provider Demographics
NPI:1649589813
Name:VALERIY BELIY DMD, PLLC
Entity Type:Organization
Organization Name:VALERIY BELIY DMD, PLLC
Other - Org Name:PRODENTAL FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:VALERIY
Authorized Official - Middle Name:
Authorized Official - Last Name:BELIY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:425-673-8919
Mailing Address - Street 1:3005 ALDERWOOD MALL PKWY
Mailing Address - Street 2:STE 200
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98036-6920
Mailing Address - Country:US
Mailing Address - Phone:425-673-8919
Mailing Address - Fax:425-673-5674
Practice Address - Street 1:3005 ALDERWOOD MALL PKWY
Practice Address - Street 2:STE 200
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036-6920
Practice Address - Country:US
Practice Address - Phone:425-673-8919
Practice Address - Fax:425-673-5674
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-05
Last Update Date:2010-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE 00008313122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5033741Medicaid