Provider Demographics
NPI:1760756837
Name:IGNATYEV, LYUDMILA (DDS)
Entity Type:Individual
Prefix:DR
First Name:LYUDMILA
Middle Name:
Last Name:IGNATYEV
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15012 110TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98011-4808
Mailing Address - Country:US
Mailing Address - Phone:425-233-9642
Mailing Address - Fax:
Practice Address - Street 1:15710 NE 24TH ST
Practice Address - Street 2:SUITE A
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98008-2444
Practice Address - Country:US
Practice Address - Phone:425-865-0411
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-06
Last Update Date:2012-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE 00010387122300000X
ORD8339122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist