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General NPI Number Information
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NPI Number | 1942062419
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Entity Type | Individual
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Provider Name | SVITLANA PAK
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Gender | Female
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Dates
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Enumeration Date | 01/29/2024
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Last Update Date | 01/17/2025
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Provider Practice Location Address
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Address Line | 50 STANIFORD ST STE 804
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City | BOSTON
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State | MA
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Zip | 02114-2537
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Country | US
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Telephone | 617-581-0689
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Fax |
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Provider Business Mailing Address
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Address Line | 14 LOON HILL RD
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City | DRACUT
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State | MA
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Zip | 01826-4015
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Country | US
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Telephone | 978-955-9005
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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 | DN10000549
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License Number State | MA
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