Provider Demographics
NPI:1013083856
Name:VASERSHTEIN, ABRAM (DMD)
Entity Type:Individual
Prefix:
First Name:ABRAM
Middle Name:
Last Name:VASERSHTEIN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 SOUTH STREET
Mailing Address - Street 2:
Mailing Address - City:NORTHBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01532
Mailing Address - Country:US
Mailing Address - Phone:508-393-7495
Mailing Address - Fax:508-393-4294
Practice Address - Street 1:29 SOUTH STREET
Practice Address - Street 2:
Practice Address - City:NORTHBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01532
Practice Address - Country:US
Practice Address - Phone:508-393-7495
Practice Address - Fax:508-393-4294
Is Sole Proprietor?:No
Enumeration Date:2006-11-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA185371223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0278327Medicaid