Provider Demographics
NPI:1689974156
Name:BABIY, ILYA (RDH, MS, EPP)
Entity Type:Individual
Prefix:
First Name:ILYA
Middle Name:
Last Name:BABIY
Suffix:
Gender:M
Credentials:RDH, MS, EPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26000 SE STARK ST
Mailing Address - Street 2:
Mailing Address - City:GRESHAM
Mailing Address - State:OR
Mailing Address - Zip Code:97030-3300
Mailing Address - Country:US
Mailing Address - Phone:503-729-2361
Mailing Address - Fax:
Practice Address - Street 1:26000 SE STARK ST
Practice Address - Street 2:
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97030-3300
Practice Address - Country:US
Practice Address - Phone:503-729-2361
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-29
Last Update Date:2015-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORH5253124Q00000X
WADH00007943124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist