Organization
EVERETT DENTAL MANAGEMENT CO.
Active
Other names
everett dental
Organization subpart
No
Provider details
NPI number
Authorized official
DR. EKATERINA MAMULASHILI D.M.D (OWNER)
(617) 389-2005
Entity
Organization
Contact information
Practice address
459 BROADWAY, EVERETT, MA 02149-3614
(617) 389-2005
(617) 389-1007
Mailing address
459 BROADWAY, EVERETT, MA 02149-3614
(617) 389-2005
(617) 389-1007
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
21211
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
9756761
—
MA
Enumeration date
10/14/2006
Last updated
08/22/2020
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