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General NPI Number Information
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NPI Number | 1356704266
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Entity Type | Organization
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Legal Business Name | NY DENTAL PC
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Dates
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Enumeration Date | 03/30/2016
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Last Update Date | 04/01/2016
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Provider Practice Location Address
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Address Line | 83 CAMBRIDGE ST STE 3A
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City | BURLINGTON
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State | MA
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Zip | 01803-4181
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Country | US
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Telephone | 781-265-4500
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Fax | 781-265-4246
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Provider Business Mailing Address
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Address Line | 83 CAMBRIDGE ST STE 3A
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City | BURLINGTON
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State | MA
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Zip | 01803-4181
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Country | US
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Telephone | 781-265-4500
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Fax | 781-265-4246
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. NATASHA S YEGOROV
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Credential | DMD
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Telephone | 917-753-8444
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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 | DN1855745
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License Number State | MA
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