Provider Demographics
NPI:1457752271
Name:CHRISTIN, SVETLANA (DMD)
Entity Type:Individual
Prefix:
First Name:SVETLANA
Middle Name:
Last Name:CHRISTIN
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 1:22 JUNIPER ST
Mailing Address - Street 2:
Mailing Address - City:WENHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01984-1454
Mailing Address - Country:US
Mailing Address - Phone:218-251-7404
Mailing Address - Fax:
Practice Address - Street 1:968 MAIN ST
Practice Address - Street 2:
Practice Address - City:WAKEFIELD
Practice Address - State:MA
Practice Address - Zip Code:01880-3989
Practice Address - Country:US
Practice Address - Phone:781-780-4276
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-11
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN18566761223G0001X
MA18566761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MADN1856676OtherSTATE OF MASSACHUSETTS