Provider Demographics
NPI:1457036261
Name:BYA, ELENA OLEGOVNA (DDS)
Entity Type:Individual
Prefix:DR
First Name:ELENA
Middle Name:OLEGOVNA
Last Name:BYA
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 1:2034 BELLEFONTAINE ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46202-1856
Mailing Address - Country:US
Mailing Address - Phone:812-325-7761
Mailing Address - Fax:
Practice Address - Street 1:6202 EVANSTON AVE
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46220-2100
Practice Address - Country:US
Practice Address - Phone:317-251-0085
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-19
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12014068A122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist