Provider Demographics
NPI:1972787059
Name:BUDIYANSKAYA, INNA (DDS)
Entity Type:Individual
Prefix:
First Name:INNA
Middle Name:
Last Name:BUDIYANSKAYA
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 1:1208 FLATBUSH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11226-7005
Mailing Address - Country:US
Mailing Address - Phone:718-282-8066
Mailing Address - Fax:718-282-8003
Practice Address - Street 1:1208 FLATBUSH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11226-7005
Practice Address - Country:US
Practice Address - Phone:718-282-8066
Practice Address - Fax:718-282-8003
Is Sole Proprietor?:No
Enumeration Date:2007-12-25
Last Update Date:2007-12-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY052425122300000X
NJ22DI02323600122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02712316Medicaid