| Full Name | |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 231 Border St, Boston, Massachusetts |
| Authorized Official Name and Position | Anna Pukhovitskaya (OWNER) |
| Authorized Official Contact | 9782233742 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
305 Sumner St Unit 3 Boston MA 02128-2123 Ph: (978) 223-3742 | 231 Border St Boston MA 02128-1619 Ph: (978) 223-3742 |
| NPI Number | 1063921021 |
|---|---|
| Provider Enumeration Date | 09/21/2017 |
| Last Update Date | 09/21/2017 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1063921021 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 1856277 (Massachusetts) | Primary |
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