Provider Demographics
NPI:1902124878
Name:LANDMARK DENTAL
Entity Type:Organization
Organization Name:LANDMARK DENTAL
Other - Org Name:ILYA LIVSHIN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ILYA
Authorized Official - Middle Name:
Authorized Official - Last Name:LIVSHIN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:781-688-0248
Mailing Address - Street 1:77 ACCESS RD STE 1
Mailing Address - Street 2:
Mailing Address - City:NORWOOD
Mailing Address - State:MA
Mailing Address - Zip Code:02062-5244
Mailing Address - Country:US
Mailing Address - Phone:781-688-0248
Mailing Address - Fax:781-688-0267
Practice Address - Street 1:77 ACCESS RD STE 1
Practice Address - Street 2:
Practice Address - City:NORWOOD
Practice Address - State:MA
Practice Address - Zip Code:02062-5244
Practice Address - Country:US
Practice Address - Phone:781-688-0248
Practice Address - Fax:781-688-0267
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-17
Last Update Date:2010-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty