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General NPI Number Information
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NPI Number | 1427311471
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Entity Type | Individual
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Provider Name | ILYOSS GULYAMOV D.M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/24/2012
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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 | 8 KIMBALL CT APT 306
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City | BURLINGTON
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State | MA
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Zip | 01803-3843
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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 |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DN1856045
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License Number State | MA
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