| Everett Dental | |
|
459 Broadway Everett MA 02149-3614 | |
| (617) 389-2005 | |
| (617) 389-1007 |
| Full Name | Everett Dental |
|---|---|
| Speciality | Dentist |
| Location | 459 Broadway, Everett, Massachusetts |
| Authorized Official Name and Position | Ekaterina Mamulashili (OWNER) |
| Authorized Official Contact | 6173892005 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Everett Dental 459 Broadway Everett MA 02149-3614 Ph: (617) 389-2005 | Everett Dental 459 Broadway Everett MA 02149-3614 Ph: (617) 389-2005 |
| NPI Number | 1255421699 |
|---|---|
| Provider Enumeration Date | 10/14/2006 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1255421699 | NPI | - | NPPES |
| 9756761 | Medicaid | MA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 21211 (Massachusetts) | Primary |
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