Full Name | |
---|---|
Speciality | Dentist - General Practice |
Location | 55 Oak Road, North Eastham, Massachusetts |
Authorized Official Name and Position | Nadezhda Pokrovskaya (OWNER) |
Authorized Official Contact | 5082550557 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
---|---|
Po Box 1890 North Eastham MA 02651-1890 Ph: () - | 55 Oak Road North Eastham MA 02651 Ph: (508) 255-0557 |
NPI Number | 1659626919 |
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Provider Enumeration Date | 07/23/2012 |
Last Update Date | 07/23/2012 |
Identifier | Type | State | Issuer |
---|---|---|---|
1659626919 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
1223G0001X | Dentist - General Practice | DN1855124 (Massachusetts) | Primary |