Healthcare Provider Details

I. General information

NPI: 1427502608
Provider Name (Legal Business Name): MAJLINDA VAKA DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2016
Last Update Date: 08/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

86 ELLIOTT ST
DANVERS MA
01923-3439
US

IV. Provider business mailing address

86 ELLIOTT STREET
DANVERS MA
01923
US

V. Phone/Fax

Practice location:
  • Phone: 978-223-3787
  • Fax:
Mailing address:
  • Phone: 978-223-3787
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN1857306
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: