Organization
LP DENTAL, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANNA PUKHOVITSKAYA DMD (OWNER)
(978) 223-3742
Entity
Organization
Contact information
Practice address
990 PARADISE RD, SWAMPSCOTT, MA 01907-1395
(978) 223-3742
Mailing address
591 E BROADWAY, SOUTH BOSTON, MA 02127-4404
(617) 268-5638
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1356358014
GENERAL DENTIST
—
Enumeration date
05/31/2018
Last updated
05/31/2018
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