Provider Demographics
NPI:1942062419
Name:PAK, SVITLANA
Entity type:Individual
Prefix:
First Name:SVITLANA
Middle Name:
Last Name:PAK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 LOON HILL RD
Mailing Address - Street 2:
Mailing Address - City:DRACUT
Mailing Address - State:MA
Mailing Address - Zip Code:01826-4015
Mailing Address - Country:US
Mailing Address - Phone:978-955-9005
Mailing Address - Fax:
Practice Address - Street 1:50 STANIFORD ST STE 804
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2537
Practice Address - Country:US
Practice Address - Phone:617-581-0689
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-29
Last Update Date:2025-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN10000549122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist