Provider Demographics
NPI:1700335619
Name:ALLA SHIKHANOVICH DMD, PC
Entity Type:Organization
Organization Name:ALLA SHIKHANOVICH DMD, PC
Other - Org Name:PRIMA FAMILY DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALLA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHIKHANOVICH
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:781-944-4450
Mailing Address - Street 1:315 MAIN ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:READING
Mailing Address - State:MA
Mailing Address - Zip Code:01867-3666
Mailing Address - Country:US
Mailing Address - Phone:781-944-4450
Mailing Address - Fax:781-944-4451
Practice Address - Street 1:315 MAIN ST
Practice Address - Street 2:SUITE 101
Practice Address - City:READING
Practice Address - State:MA
Practice Address - Zip Code:01867-3666
Practice Address - Country:US
Practice Address - Phone:781-944-4450
Practice Address - Fax:781-944-4451
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-03
Last Update Date:2016-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA22249261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental