Provider Demographics
NPI:1578001350
Name:FOR A NEW YOU PC
Entity Type:Organization
Organization Name:FOR A NEW YOU PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST, OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:
Authorized Official - Last Name:PREUSSNER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:774-217-0056
Mailing Address - Street 1:479 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:HOLLISTON
Mailing Address - State:MA
Mailing Address - Zip Code:01746-1828
Mailing Address - Country:US
Mailing Address - Phone:508-429-7125
Mailing Address - Fax:
Practice Address - Street 1:479 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:HOLLISTON
Practice Address - State:MA
Practice Address - Zip Code:01746-1828
Practice Address - Country:US
Practice Address - Phone:508-429-7125
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-01
Last Update Date:2017-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA17180122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty