Provider Demographics
NPI:1144549155
Name:CUCEROV, LILIA (DMD)
Entity type:Individual
Prefix:DR
First Name:LILIA
Middle Name:
Last Name:CUCEROV
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 MOUNT IDA ST APT 4
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02458-1986
Mailing Address - Country:US
Mailing Address - Phone:617-467-5205
Mailing Address - Fax:
Practice Address - Street 1:644 AMERICAN LEGION HWY
Practice Address - Street 2:
Practice Address - City:ROSLINDALE
Practice Address - State:MA
Practice Address - Zip Code:02131-3901
Practice Address - Country:US
Practice Address - Phone:617-390-7090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-01
Last Update Date:2010-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN18553901223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice