Provider Demographics
NPI:1558004549
Name:SARTBAEVA, ERKINA
Entity type:Individual
Prefix:
First Name:ERKINA
Middle Name:
Last Name:SARTBAEVA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 NEW ST APT 905
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02128-2389
Mailing Address - Country:US
Mailing Address - Phone:203-571-8034
Mailing Address - Fax:
Practice Address - Street 1:990 PARADISE RD STE 2C
Practice Address - Street 2:
Practice Address - City:SWAMPSCOTT
Practice Address - State:MA
Practice Address - Zip Code:01907-1309
Practice Address - Country:US
Practice Address - Phone:781-384-6646
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-18
Last Update Date:2024-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN100004271223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice