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General NPI Number Information
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NPI Number | 1619230364
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Entity Type | Organization
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Legal Business Name | PREMIER ENDODONTICS LLC
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Dates
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Enumeration Date | 06/18/2012
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Last Update Date | 06/18/2012
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Provider Practice Location Address
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Address Line | 271 WAVERLEY OAKS RD STE 101
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City | WALTHAM
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State | MA
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Zip | 02452-8475
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Country | US
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Telephone | 617-935-1528
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Fax |
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Provider Business Mailing Address
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Address Line | 15 RIVER PARK ST
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City | NEEDHAM
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State | MA
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Zip | 02494-2616
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Country | US
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Telephone | 617-935-1528
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Fax |
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Authorized Official
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Title or Position | MANAGER/OWNER
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Name | DR. BELLA BATSEVITSKY
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Credential | D.M.D.
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Telephone | 617-935-1528
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | DN1855136
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License Number State | MA
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