Stanislav Kovtun, D.M.D
Dentist, General Practice in Brookline, MA. Individual provider (NPI-1).
NPI number1699112151
StatusActive
Last updated in NPPESOct 27, 2020
Details
- NPI
- 1699112151
- Entity type
- Individual (NPI-1)
- Name
- Stanislav Kovtun
- Credential
- D.M.D
- Sex
- Male
- Sole proprietor
- Yes
- Enumeration date
- May 23, 2013
- Certification date
- Oct 23, 2020
- Last updated
- Oct 27, 2020
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 1223G0001X | Dentist, General Practice | DN1856247 | MA | Yes |
Practice location
185 Harvard StBrookline, MA 02446-5013
Phone 617-274-8494
Mailing address
25 Shuman CirNewton, MA 02459-2767
Phone 781-264-2067
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