Provider Demographics
NPI:1912071325
Name:ANNA ZABOROVSKY DENTAL PRACTICE INC
Entity Type:Organization
Organization Name:ANNA ZABOROVSKY DENTAL PRACTICE INC
Other - Org Name:FAMILY DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:ZABOROVSKY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:781-551-0235
Mailing Address - Street 1:648 WASHINGTON ST
Mailing Address - Street 2:204
Mailing Address - City:NORWOOD
Mailing Address - State:MA
Mailing Address - Zip Code:02062
Mailing Address - Country:US
Mailing Address - Phone:781-551-0235
Mailing Address - Fax:781-551-0428
Practice Address - Street 1:648 WASHINGTON ST
Practice Address - Street 2:204
Practice Address - City:NORWOOD
Practice Address - State:MA
Practice Address - Zip Code:02062
Practice Address - Country:US
Practice Address - Phone:781-551-0235
Practice Address - Fax:781-551-0428
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA184261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0277495Medicare ID - Type Unspecified