Provider Demographics
NPI:1962011973
Name:YAKOVLEV, GALINA ALEXANDRA
Entity Type:Individual
Prefix:
First Name:GALINA
Middle Name:ALEXANDRA
Last Name:YAKOVLEV
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1222 MAINSTREET
Mailing Address - Street 2:
Mailing Address - City:HOPKINS
Mailing Address - State:MN
Mailing Address - Zip Code:55343-8877
Mailing Address - Country:US
Mailing Address - Phone:952-836-1113
Mailing Address - Fax:
Practice Address - Street 1:1222 MAINSTREET
Practice Address - Street 2:
Practice Address - City:HOPKINS
Practice Address - State:MN
Practice Address - Zip Code:55343-8877
Practice Address - Country:US
Practice Address - Phone:952-836-1113
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-26
Last Update Date:2022-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND14419122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist