Provider Demographics
NPI:1083736185
Name:NEWBURYPORT PEDIATRIC DENTISTRY, P.C.
Entity Type:Organization
Organization Name:NEWBURYPORT PEDIATRIC DENTISTRY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LINDI
Authorized Official - Middle Name:JANE
Authorized Official - Last Name:EZEKOWITZ
Authorized Official - Suffix:
Authorized Official - Credentials:DR
Authorized Official - Phone:978-462-2227
Mailing Address - Street 1:7 GRAF RD STE 2A
Mailing Address - Street 2:
Mailing Address - City:NEWBURYPORT
Mailing Address - State:MA
Mailing Address - Zip Code:01950-4078
Mailing Address - Country:US
Mailing Address - Phone:978-462-2227
Mailing Address - Fax:
Practice Address - Street 1:7 GRAF RD STE 2A
Practice Address - Street 2:
Practice Address - City:NEWBURYPORT
Practice Address - State:MA
Practice Address - Zip Code:01950-4078
Practice Address - Country:US
Practice Address - Phone:978-462-2227
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-06
Last Update Date:2020-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA210581223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty