Healthcare Provider Details

I. General information

NPI: 1043125818
Provider Name (Legal Business Name): CHAIR CITY DENTAL PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2026
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39 LENNON ST
GARDNER MA
01440-3907
US

IV. Provider business mailing address

39 LENNON ST
GARDNER MA
01440-3907
US

V. Phone/Fax

Practice location:
  • Phone: 978-632-5502
  • Fax:
Mailing address:
  • Phone: 978-632-5502
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: ABULFAZ ISAYEV
Title or Position: DENTIST
Credential: DMD
Phone: 857-333-6948