Provider Demographics
NPI:1770822371
Name:A DENTAL GROUP
Entity Type:Organization
Organization Name:A DENTAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:YURI
Authorized Official - Middle Name:
Authorized Official - Last Name:MURZIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:413-374-1262
Mailing Address - Street 1:1 S END BRIDGE CIR
Mailing Address - Street 2:
Mailing Address - City:AGAWAM
Mailing Address - State:MA
Mailing Address - Zip Code:01001-2020
Mailing Address - Country:US
Mailing Address - Phone:413-363-1242
Mailing Address - Fax:
Practice Address - Street 1:1 S END BRIDGE CIR
Practice Address - Street 2:
Practice Address - City:AGAWAM
Practice Address - State:MA
Practice Address - Zip Code:01001-2020
Practice Address - Country:US
Practice Address - Phone:413-363-1242
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-04
Last Update Date:2013-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223D0001XDental ProvidersDentistDental Public HealthGroup - Single Specialty