Provider Demographics
NPI:1821334566
Name:NATASHA VEKSLER DMD CORPORATION
Entity Type:Organization
Organization Name:NATASHA VEKSLER DMD CORPORATION
Other - Org Name:ATLANTIC AVE. DENTAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NATASHA
Authorized Official - Middle Name:
Authorized Official - Last Name:VEKSLER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:617-556-2611
Mailing Address - Street 1:183 ESSEX STREET
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02111
Mailing Address - Country:US
Mailing Address - Phone:857-239-6368
Mailing Address - Fax:857-239-8370
Practice Address - Street 1:183 ESSEX STREET
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02111
Practice Address - Country:US
Practice Address - Phone:857-239-6368
Practice Address - Fax:857-239-8370
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-28
Last Update Date:2020-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA18636261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental