Provider Demographics
NPI:1063921021
Name:AP DENTAL PLLC
Entity type:Organization
Organization Name:AP DENTAL PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:PUKHOVITSKAYA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:978-223-3742
Mailing Address - Street 1:305 SUMNER ST UNIT 3
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02128-2123
Mailing Address - Country:US
Mailing Address - Phone:978-223-3742
Mailing Address - Fax:
Practice Address - Street 1:231 BORDER ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02128-1619
Practice Address - Country:US
Practice Address - Phone:978-223-3742
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-21
Last Update Date:2017-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA18562771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty