Provider Demographics
NPI:1336527696
Name:DENTAL ARTS OF LYNN
Entity Type:Organization
Organization Name:DENTAL ARTS OF LYNN
Other - Org Name:TASHKENT DENTAL INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST, PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ILYOSS
Authorized Official - Middle Name:
Authorized Official - Last Name:GULYAMOV
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:866-942-5444
Mailing Address - Street 1:60 LEWIS ST
Mailing Address - Street 2:SUITE 6
Mailing Address - City:LYNN
Mailing Address - State:MA
Mailing Address - Zip Code:01902-4858
Mailing Address - Country:US
Mailing Address - Phone:866-942-5444
Mailing Address - Fax:866-942-5444
Practice Address - Street 1:60 LEWIS ST
Practice Address - Street 2:SUITE 6
Practice Address - City:LYNN
Practice Address - State:MA
Practice Address - Zip Code:01902-4858
Practice Address - Country:US
Practice Address - Phone:866-942-5444
Practice Address - Fax:866-942-5444
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TASHKENT DENTAL INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-05-07
Last Update Date:2015-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN1856045261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110097277AMedicaid