Provider Demographics
NPI:1386053155
Name:JURGINA ELEZI DMD LLC
Entity type:Organization
Organization Name:JURGINA ELEZI DMD LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JURGINA
Authorized Official - Middle Name:
Authorized Official - Last Name:ELEZI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:781-284-4100
Mailing Address - Street 1:7 FOSTER ST STE 1
Mailing Address - Street 2:
Mailing Address - City:REVERE
Mailing Address - State:MA
Mailing Address - Zip Code:02151-3419
Mailing Address - Country:US
Mailing Address - Phone:781-284-4100
Mailing Address - Fax:
Practice Address - Street 1:7 FOSTER ST STE 1
Practice Address - Street 2:
Practice Address - City:REVERE
Practice Address - State:MA
Practice Address - Zip Code:02151-3419
Practice Address - Country:US
Practice Address - Phone:781-284-4100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-06
Last Update Date:2014-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN21646261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental