Provider Demographics
NPI:1891810180
Name:KRAVETSKAYA, NATALYA IOSIFOVNA (DMD)
Entity Type:Individual
Prefix:MRS
First Name:NATALYA
Middle Name:IOSIFOVNA
Last Name:KRAVETSKAYA
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 1:104 STANLEY RD
Mailing Address - Street 2:
Mailing Address - City:SWAMPSCOTT
Mailing Address - State:MA
Mailing Address - Zip Code:01907-1459
Mailing Address - Country:US
Mailing Address - Phone:781-593-6958
Mailing Address - Fax:
Practice Address - Street 1:30 STATE ST
Practice Address - Street 2:
Practice Address - City:LYNN
Practice Address - State:MA
Practice Address - Zip Code:01901-1505
Practice Address - Country:US
Practice Address - Phone:781-595-8606
Practice Address - Fax:781-595-8370
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA192231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0282146Medicaid