Provider Demographics
NPI:1619230364
Name:PREMIER ENDODONTICS LLC
Entity Type:Organization
Organization Name:PREMIER ENDODONTICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BELLA
Authorized Official - Middle Name:
Authorized Official - Last Name:BATSEVITSKY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:617-935-1528
Mailing Address - Street 1:15 RIVER PARK ST
Mailing Address - Street 2:
Mailing Address - City:NEEDHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02494-2616
Mailing Address - Country:US
Mailing Address - Phone:617-935-1528
Mailing Address - Fax:
Practice Address - Street 1:271 WAVERLEY OAKS RD STE 101
Practice Address - Street 2:
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02452-8475
Practice Address - Country:US
Practice Address - Phone:617-935-1528
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-18
Last Update Date:2012-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN18551361223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty