Individual
ILYA B MIRONOV
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
OJH CLINIC NO 5 BURLINGTON FAMILY DENTISTRY, 1250 S BURLINGTON BLVD, BURLINGTON, WA 98233
(360) 755-5600
Mailing address
2385 HUGHES AVE SW, SEATTLE, WA 98116-1835
(206) 383-7373
Taxonomy
Speciality
Code
Description
License number
State
1223D0001X
Public Health Dentistry
Primary
DE 00010565
WA
Other
Enumeration date
12/11/2006
Last updated
07/08/2007
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