Provider Demographics
NPI:1003943895
Name:NATALYA I KRAVETSKAYA DMD PC
Entity Type:Organization
Organization Name:NATALYA I KRAVETSKAYA DMD PC
Other - Org Name:WELCOME DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:NATALYA
Authorized Official - Middle Name:IOSIFOVNA
Authorized Official - Last Name:KRAVETSKAYA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:781-595-8606
Mailing Address - Street 1:30 STATE ST
Mailing Address - Street 2:
Mailing Address - City:LYNN
Mailing Address - State:MA
Mailing Address - Zip Code:01901-1505
Mailing Address - Country:US
Mailing Address - Phone:781-595-8606
Mailing Address - Fax:781-595-8370
Practice Address - Street 1:30 STATE ST
Practice Address - Street 2:
Practice Address - City:LYNN
Practice Address - State:MA
Practice Address - Zip Code:01901-1505
Practice Address - Country:US
Practice Address - Phone:781-595-8606
Practice Address - Fax:781-595-8370
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA192231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0282146Medicaid