Provider Demographics
NPI:1285037515
Name:MITTELMAN, LIA (DMD)
Entity Type:Individual
Prefix:DR
First Name:LIA
Middle Name:
Last Name:MITTELMAN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:488 ESSEX ST
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:MA
Mailing Address - Zip Code:01840-1242
Mailing Address - Country:US
Mailing Address - Phone:978-975-8888
Mailing Address - Fax:
Practice Address - Street 1:488 ESSEX ST
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:MA
Practice Address - Zip Code:01840-1242
Practice Address - Country:US
Practice Address - Phone:603-886-0000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-01
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH04232122300000X
MEDEN4427122300000X
MADN1856748122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist