Provider Demographics
NPI:1659626919
Name:NADEZHDA D. POKROVSKAYA, DMD, PC
Entity Type:Organization
Organization Name:NADEZHDA D. POKROVSKAYA, DMD, PC
Other - Org Name:DENTAL ARTS STUDIO OF CAPE COD
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NADEZHDA
Authorized Official - Middle Name:
Authorized Official - Last Name:POKROVSKAYA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-255-0557
Mailing Address - Street 1:PO BOX 1890
Mailing Address - Street 2:
Mailing Address - City:NORTH EASTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02651-1890
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:55 OAK ROAD
Practice Address - Street 2:
Practice Address - City:NORTH EASTHAM
Practice Address - State:MA
Practice Address - Zip Code:02651
Practice Address - Country:US
Practice Address - Phone:508-255-0557
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-23
Last Update Date:2012-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN18551241223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty