Provider Demographics
NPI:1184807380
Name:CROSS POINT FAMILY DENTAL, P.C.
Entity type:Organization
Organization Name:CROSS POINT FAMILY DENTAL, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EDUARD
Authorized Official - Middle Name:
Authorized Official - Last Name:PEYSAKHOV
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:978-459-6467
Mailing Address - Street 1:850 CHELMSFORD ST
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:MA
Mailing Address - Zip Code:01851-5149
Mailing Address - Country:US
Mailing Address - Phone:978-459-6467
Mailing Address - Fax:978-458-1857
Practice Address - Street 1:850 CHELMSFORD ST
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01851-5149
Practice Address - Country:US
Practice Address - Phone:978-459-6467
Practice Address - Fax:978-458-1857
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-11
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA19639261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental