Provider Demographics
NPI:1669246864
Name:BOINIK, ANYA V (DDS)
Entity type:Individual
Prefix:
First Name:ANYA
Middle Name:V
Last Name:BOINIK
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:GANNA
Other - Middle Name:VADIMIVNA
Other - Last Name:BOINIK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11109 NE 124TH LN APT B208
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-6421
Mailing Address - Country:US
Mailing Address - Phone:628-628-6972
Mailing Address - Fax:
Practice Address - Street 1:239 S BURLINGTON BLVD
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:WA
Practice Address - Zip Code:98233-1708
Practice Address - Country:US
Practice Address - Phone:360-707-5353
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-08
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE614788631223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice