Individual provider Active NPI

Ilya Miloslavskiy, D.D.S

  • General Practice Dentistry
  • Bellevue, WA
National Provider Identifier
1417091943
Registry record updated Jun 7, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
052222 Issued in NY
Practice address
1130 140TH Ave NE Ste 100B
Bellevue, WA 98005
Phone
(425) 746-6090
Fax
(425) 747-9856
NPI assigned
Feb 17, 2007
Last updated
Jun 7, 2018By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 7, 2018

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 052222 NY Primary
Prosthodontics 1223P0700X 60452580 WA

Addresses

Primary practice location

1130 140TH Ave NE Ste 100B
Bellevue, WA 98005

Mailing address

313 Avenue of the Americas
Apt. 1a
New York, NY 10014-4445
Phone (917) 658-4575

Other identifiers 1

IdentifierTypeStateIssuer
02771488MedicaidNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
052222NYMDGeneral Practice Dentistry
60452580WAMDProsthodontist

Practice roles

OrganizationSpecialtyStatusNew patients
Onesmile NW Holdings, PLLC Prosthodontics Current Accepting new patients
Ez Dent Denture Clinic Inc Past Accepting new patients

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1171670400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1528329600000",
    "number": "1417091943",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "313 AVENUE OF THE AMERICAS",
            "address_2": "APT. 1A",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100144445",
            "telephone_number": "917-658-4575"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1130 140TH AVE NE STE 100B",
            "city": "BELLEVUE",
            "state": "WA",
            "postal_code": "98005",
            "telephone_number": "425-746-6090",
            "fax_number": "425-747-9856"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MILOSLAVSKIY",
        "first_name": "ILYA",
        "credential": "D.D.S",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-02-17",
        "last_updated": "2018-06-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NY",
            "license": "052222",
            "primary": true
        },
        {
            "code": "1223P0700X",
            "taxonomy_group": "",
            "desc": "Dentist, Prosthodontics",
            "state": "WA",
            "license": "60452580",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02771488",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bellevue, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 7, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.