Healthcare Provider Details

I. General information

NPI: 1659283141
Provider Name (Legal Business Name): MARY YUZBASHEVA DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2026
Last Update Date: 09/19/2026
Certification Date: 09/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 WARREN ST
BOSTON MA
02119-1850
US

IV. Provider business mailing address

333 WARREN ST
BOSTON MA
02119-1850
US

V. Phone/Fax

Practice location:
  • Phone: 617-427-4242
  • Fax:
Mailing address:
  • Phone: 617-427-4242
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN10001510
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: