Provider Demographics
NPI:1235519786
Name:ZELIKOV, ANDRE (DMD)
Entity Type:Individual
Prefix:DR
First Name:ANDRE
Middle Name:
Last Name:ZELIKOV
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1375 COMMONWEALTH AVE
Mailing Address - Street 2:APT 2
Mailing Address - City:ALLSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02134-3338
Mailing Address - Country:US
Mailing Address - Phone:248-558-9476
Mailing Address - Fax:
Practice Address - Street 1:55 MERIDIAN ST
Practice Address - Street 2:
Practice Address - City:EAST BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02128-1959
Practice Address - Country:US
Practice Address - Phone:617-567-1300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-30
Last Update Date:2015-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN1856870122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist