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General NPI Number Information
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NPI Number | 1043881170
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Entity Type | Organization
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Legal Business Name | VLADIMIR NAZAROV PC
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Dates
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Enumeration Date | 07/09/2021
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Last Update Date | 10/20/2021
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Provider Practice Location Address
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Address Line | 205 SOUTH ST
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City | PITTSFIELD
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State | MA
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Zip | 01201-6837
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Country | US
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Telephone | 413-443-9013
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Fax |
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Provider Business Mailing Address
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Address Line | 205 SOUTH ST
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City | PITTSFIELD
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State | MA
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Zip | 01201-6837
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Country | US
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Telephone | 413-443-9013
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | VLADIMIR NAZAROV
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Credential | DMD
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Telephone | 202-909-5272
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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