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50 Staniford St 303 Boston MA 02114-2517 | |
| (617) 523-4555 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 50 Staniford St, Boston, Massachusetts |
| Authorized Official Name and Position | Sergio A Guzman (MANAGING MEMBER) |
| Authorized Official Contact | 6175234555 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
50 Staniford St 303 Boston MA 02114-2517 Ph: (617) 523-4555 | 50 Staniford St 303 Boston MA 02114-2517 Ph: (617) 523-4555 |
| NPI Number | 1043741143 |
|---|---|
| Provider Enumeration Date | 03/21/2017 |
| Last Update Date | 03/21/2017 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1043741143 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | DN20823 (Massachusetts) | Primary |
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