Provider Demographics
NPI:1770022055
Name:DENTAL AID 1
Entity Type:Organization
Organization Name:DENTAL AID 1
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:OLGA
Authorized Official - Middle Name:
Authorized Official - Last Name:KRASNOSLOBODTSEVA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:781-340-5361
Mailing Address - Street 1:884 WASHINGTON ST
Mailing Address - Street 2:130
Mailing Address - City:WEYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02189-1530
Mailing Address - Country:US
Mailing Address - Phone:781-340-5361
Mailing Address - Fax:
Practice Address - Street 1:884 WASHINGTON ST
Practice Address - Street 2:130
Practice Address - City:WEYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02189-1530
Practice Address - Country:US
Practice Address - Phone:781-340-5361
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-20
Last Update Date:2017-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN 1856680261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental