Provider Demographics
NPI:1033828272
Name:NORTH ST PERIODONTICS PLLC
Entity Type:Organization
Organization Name:NORTH ST PERIODONTICS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:YANA
Authorized Official - Middle Name:
Authorized Official - Last Name:AMIRIAN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:978-256-3301
Mailing Address - Street 1:50 PANTRY RD
Mailing Address - Street 2:
Mailing Address - City:SUDBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01776-1113
Mailing Address - Country:US
Mailing Address - Phone:617-291-7094
Mailing Address - Fax:
Practice Address - Street 1:18 NORTH RD
Practice Address - Street 2:
Practice Address - City:CHELMSFORD
Practice Address - State:MA
Practice Address - Zip Code:01824-2736
Practice Address - Country:US
Practice Address - Phone:978-256-3301
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-16
Last Update Date:2022-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty
No1223D0001XDental ProvidersDentistDental Public HealthGroup - Single Specialty