| |
1058 Cambridge St Cambridge MA 02139-1407 | |
(617) 868-2545 | |
Not Available |
Full Name | |
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Speciality | Clinic/center - Dental |
Location | 1058 Cambridge St, Cambridge, Massachusetts |
Authorized Official Name and Position | Marie B Jean-mary (OWNER/CEO) |
Authorized Official Contact | 6178682545 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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1058 Cambridge St Cambridge MA 02139-1407 Ph: (617) 868-2545 | 1058 Cambridge St Cambridge MA 02139-1407 Ph: (617) 868-2545 |
NPI Number | 1649772260 |
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Provider Enumeration Date | 02/28/2018 |
Last Update Date | 02/28/2018 |
Identifier | Type | State | Issuer |
---|---|---|---|
1649772260 | NPI | - | NPPES |
110100017A | Medicaid | MA |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QD0000X | Clinic/center - Dental | 18588 (Massachusetts) | Primary |
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