Organization
ATLANTIC DENTAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ILYA VASSERMAN (PRESIDENT)
(781) 599-3553
Entity
Organization
Contact information
Practice address
153 LEWIS ST, LYNN, MA 01902-4835
(781) 599-3553
(781) 599-5959
Mailing address
153 LEWIS ST, LYNN, MA 01902-4835
(781) 599-3553
(781) 599-5959
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
20020
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0201421
—
MA
Enumeration date
04/01/2008
Last updated
04/01/2008
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