Provider Demographics
NPI:1821639063
Name:FAMILY DENTISTRY OF PALMER P LLC
Entity Type:Organization
Organization Name:FAMILY DENTISTRY OF PALMER P LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MIKHAIL
Authorized Official - Middle Name:Y
Authorized Official - Last Name:TSESIS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:860-985-2592
Mailing Address - Street 1:711 FARMINGTON AVE APT A3
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06119-1737
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1055 PARK ST
Practice Address - Street 2:
Practice Address - City:PALMER
Practice Address - State:MA
Practice Address - Zip Code:01069-1746
Practice Address - Country:US
Practice Address - Phone:860-985-2592
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-30
Last Update Date:2019-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental