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General NPI Number Information
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NPI Number | 1134729833
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Entity Type | Organization
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Legal Business Name | AMESBURY FAMILY DENTAL LLC
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Dates
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Enumeration Date | 10/30/2020
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Last Update Date | 10/30/2020
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Provider Practice Location Address
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Address Line | 205A ELM ST
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City | AMESBURY
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State | MA
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Zip | 01913-3820
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Country | US
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Telephone | 773-543-3747
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Fax |
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Provider Business Mailing Address
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Address Line | 5 WINTHROP ST
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City | STONEHAM
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State | MA
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Zip | 02180-2550
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Country | US
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Telephone | 773-543-3747
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | KATERINA CHERNYKHIVSKA
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Credential |
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Telephone | 773-543-3747
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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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