Provider Demographics
NPI:1700378270
Name:LP DENTAL, INC.
Entity Type:Organization
Organization Name:LP DENTAL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:PUKHOVITSKAYA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:978-223-3742
Mailing Address - Street 1:591 E BROADWAY
Mailing Address - Street 2:
Mailing Address - City:SOUTH BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02127-4404
Mailing Address - Country:US
Mailing Address - Phone:617-268-5638
Mailing Address - Fax:
Practice Address - Street 1:990 PARADISE RD
Practice Address - Street 2:
Practice Address - City:SWAMPSCOTT
Practice Address - State:MA
Practice Address - Zip Code:01907-1395
Practice Address - Country:US
Practice Address - Phone:978-223-3742
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-31
Last Update Date:2018-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1356358014OtherGENERAL DENTIST