Provider Demographics
NPI:1619458361
Name:VICTOR M NY AKUNDI DMD LLC
Entity Type:Organization
Organization Name:VICTOR M NY AKUNDI DMD LLC
Other - Org Name:AFFINITY DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:M
Authorized Official - Last Name:NYAKUNDI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:617-959-0673
Mailing Address - Street 1:45 WALPOLE ST
Mailing Address - Street 2:
Mailing Address - City:NORWOOD
Mailing Address - State:MA
Mailing Address - Zip Code:02062-3319
Mailing Address - Country:US
Mailing Address - Phone:781-255-1100
Mailing Address - Fax:781-255-7300
Practice Address - Street 1:45 WALPOLE ST
Practice Address - Street 2:
Practice Address - City:NORWOOD
Practice Address - State:MA
Practice Address - Zip Code:02062-3319
Practice Address - Country:US
Practice Address - Phone:781-255-1100
Practice Address - Fax:781-255-7300
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VICTOR M NY AKUNDI DMD LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-08-21
Last Update Date:2018-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN1857228261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental