Provider Demographics
NPI:1568539807
Name:ADULTS & CHILDREN DENTAL CARE
Entity Type:Organization
Organization Name:ADULTS & CHILDREN DENTAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STANISLAV
Authorized Official - Middle Name:OLEGOVICH
Authorized Official - Last Name:TOKAREV
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:781-592-4438
Mailing Address - Street 1:140 UNION ST
Mailing Address - Street 2:SUITE #303
Mailing Address - City:LYNN
Mailing Address - State:MA
Mailing Address - Zip Code:01901
Mailing Address - Country:US
Mailing Address - Phone:781-592-4438
Mailing Address - Fax:781-593-1930
Practice Address - Street 1:140 UNION ST
Practice Address - Street 2:SUITE #303
Practice Address - City:LYNN
Practice Address - State:MA
Practice Address - Zip Code:01901
Practice Address - Country:US
Practice Address - Phone:781-592-4438
Practice Address - Fax:781-593-1930
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA183331223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9783806Medicaid