Provider Demographics
NPI:1295995280
Name:HARBORSIDE DENTAL
Entity type:Organization
Organization Name:HARBORSIDE DENTAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:SERGEY
Authorized Official - Middle Name:
Authorized Official - Last Name:ZEMLYANSKY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:978-546-3821
Mailing Address - Street 1:127 EASTERN AVE
Mailing Address - Street 2:
Mailing Address - City:GLOUCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01930-1802
Mailing Address - Country:US
Mailing Address - Phone:978-546-3821
Mailing Address - Fax:978-546-3821
Practice Address - Street 1:127 EASTERN AVE
Practice Address - Street 2:
Practice Address - City:GLOUCESTER
Practice Address - State:MA
Practice Address - Zip Code:01930-1802
Practice Address - Country:US
Practice Address - Phone:978-546-3821
Practice Address - Fax:978-546-3821
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-12
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAV05039OtherBLUE CROSS AND BLUE SHIELD