Provider Demographics
NPI:1821164237
Name:SHWARTZMAN, EVETTA (DMD)
Entity Type:Individual
Prefix:MRS
First Name:EVETTA
Middle Name:
Last Name:SHWARTZMAN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2184 WASHINGTON STREET
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MA
Mailing Address - Zip Code:02021
Mailing Address - Country:US
Mailing Address - Phone:781-872-4568
Mailing Address - Fax:781-575-0183
Practice Address - Street 1:2184 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MA
Practice Address - Zip Code:02021-1145
Practice Address - Country:US
Practice Address - Phone:781-872-4568
Practice Address - Fax:781-575-0183
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA184211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1223G0001XOtherDENTAL