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2400 Massachusetts Ave Cambridge MA 02140 | |
| (617) 547-9100 | |
| (617) 547-2962 |
| Full Name | |
|---|---|
| Speciality | Dentist |
| Location | 2400 Massachusetts Ave, Cambridge, Massachusetts |
| Authorized Official Name and Position | Elisha Frank (TREASURER BUS MGR) |
| Authorized Official Contact | 6175479100 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
2400 Massachusetts Avenue Cambridge MA 02140 Ph: (617) 547-9100 | 2400 Massachusetts Ave Cambridge MA 02140 Ph: (617) 547-9100 |
| NPI Number | 1063623031 |
|---|---|
| Provider Enumeration Date | 05/24/2007 |
| Last Update Date | 10/10/2007 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1063623031 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | MA14361 (Massachusetts) | Primary |
| 1223G0001X | Dentist - General Practice | MA14361 (Massachusetts) | Secondary |
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