Healthcare Provider Details

I. General information

NPI: 1457941502
Provider Name (Legal Business Name): ST APOLLONIA DENTISTRY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2021
Last Update Date: 08/19/2024
Certification Date: 08/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 1ST ST
NORTH ANDOVER MA
01845-2407
US

IV. Provider business mailing address

7 1ST ST
NORTH ANDOVER MA
01845-2407
US

V. Phone/Fax

Practice location:
  • Phone: 978-685-5804
  • Fax:
Mailing address:
  • Phone: 978-685-5804
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: MARIAM MICHAEL
Title or Position: OFFICE MANAGER
Credential:
Phone: 978-685-5804