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General NPI Number Information
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NPI Number | 1124413000
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Entity Type | Organization
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Legal Business Name | DENTAL ARTS OF SAUGUS
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Dates
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Enumeration Date | 03/30/2015
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Last Update Date | 04/26/2015
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Provider Practice Location Address
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Address Line | 311 CENTRAL ST 1ST FLOOR
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City | SAUGUS
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State | MA
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Zip | 01906-2341
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Country | US
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Telephone | 866-942-5444
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Fax |
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Provider Business Mailing Address
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Address Line | 311 CENTRAL ST 1ST FLOOR
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City | SAUGUS
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State | MA
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Zip | 01906-2341
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Country | US
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Telephone | 866-942-5444
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ILYOSS GULYAMOV
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Credential | DMD
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Telephone | 239-248-8862
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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 | DN1856045
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License Number State | MA
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