Provider Demographics
NPI:1982945481
Name:NEWBURYPORT DENTAL TEAM, PC
Entity type:Organization
Organization Name:NEWBURYPORT DENTAL TEAM, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BOZIDAR
Authorized Official - Middle Name:L
Authorized Official - Last Name:KULJIC
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:978-457-4200
Mailing Address - Street 1:37 1/2 FORRESTER ST
Mailing Address - Street 2:
Mailing Address - City:NEWBURYPORT
Mailing Address - State:MA
Mailing Address - Zip Code:01950-1938
Mailing Address - Country:US
Mailing Address - Phone:978-465-8492
Mailing Address - Fax:978-465-2192
Practice Address - Street 1:37 1/2 FORRESTER ST
Practice Address - Street 2:
Practice Address - City:NEWBURYPORT
Practice Address - State:MA
Practice Address - Zip Code:01950-1938
Practice Address - Country:US
Practice Address - Phone:978-465-8492
Practice Address - Fax:978-465-2191
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-07
Last Update Date:2013-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA195111223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty