Provider Demographics
NPI:1144979139
Name:KARTAEV, YULIYA (CADT)
Entity type:Individual
Prefix:
First Name:YULIYA
Middle Name:
Last Name:KARTAEV
Suffix:
Gender:F
Credentials:CADT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4080 W BROADWAY AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:ROBBINSDALE
Mailing Address - State:MN
Mailing Address - Zip Code:55422-5607
Mailing Address - Country:US
Mailing Address - Phone:763-712-3214
Mailing Address - Fax:763-273-4654
Practice Address - Street 1:4080 W BROADWAY AVE STE 300
Practice Address - Street 2:
Practice Address - City:ROBBINSDALE
Practice Address - State:MN
Practice Address - Zip Code:55422-5607
Practice Address - Country:US
Practice Address - Phone:763-712-3214
Practice Address - Fax:763-273-4654
Is Sole Proprietor?:No
Enumeration Date:2022-03-18
Last Update Date:2022-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNH10216124Q00000X
MNDT112125J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes125J00000XDental ProvidersDental Therapist
No124Q00000XDental ProvidersDental Hygienist