Provider Demographics
NPI:1124599154
Name:LARISA STEIN DMD, PC-FAMILY DENTIST
Entity Type:Organization
Organization Name:LARISA STEIN DMD, PC-FAMILY DENTIST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LARISA
Authorized Official - Middle Name:
Authorized Official - Last Name:STEIN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:781-762-6688
Mailing Address - Street 1:661 WASHINGTON STREET
Mailing Address - Street 2:SUITE 211
Mailing Address - City:NORWOOD
Mailing Address - State:MA
Mailing Address - Zip Code:02062
Mailing Address - Country:US
Mailing Address - Phone:781-762-6688
Mailing Address - Fax:781-769-6605
Practice Address - Street 1:661 WASHINGTON STREET
Practice Address - Street 2:SUITE 211
Practice Address - City:NORWOOD
Practice Address - State:MA
Practice Address - Zip Code:02062
Practice Address - Country:US
Practice Address - Phone:781-762-6688
Practice Address - Fax:781-769-6605
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-17
Last Update Date:2018-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty