Provider Demographics
NPI:1720379993
Name:NEWBURYPORTPERIOLTD,PC
Entity Type:Organization
Organization Name:NEWBURYPORTPERIOLTD,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:HOWARD
Authorized Official - Middle Name:M
Authorized Official - Last Name:ZOLOT
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:978-358-7522
Mailing Address - Street 1:21 HIGHLAND AVE STE 6
Mailing Address - Street 2:
Mailing Address - City:NEWBURYPORT
Mailing Address - State:MA
Mailing Address - Zip Code:01950-3873
Mailing Address - Country:US
Mailing Address - Phone:978-358-7522
Mailing Address - Fax:978-255-2156
Practice Address - Street 1:21 HIGHLAND AVE STE 6
Practice Address - Street 2:
Practice Address - City:NEWBURYPORT
Practice Address - State:MA
Practice Address - Zip Code:01950-3873
Practice Address - Country:US
Practice Address - Phone:978-358-7522
Practice Address - Fax:978-255-2156
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-22
Last Update Date:2011-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAMA156121223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty