| Full Name | |
|---|---|
| Speciality | Dentist |
| Location | 140 Fenway, Boston, Massachusetts |
| Authorized Official Name and Position | Richard Niederman (DIRECTOR CENTER FOR EVIDENCE BASED) |
| Authorized Official Contact | 6172625200 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
140 Fenway Boston MA 02115 Ph: (617) 262-5200 | 140 Fenway Boston MA 02115 Ph: (617) 262-5200 |
| NPI Number | 1497977177 |
|---|---|
| Provider Enumeration Date | 05/03/2007 |
| Last Update Date | 12/09/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1497977177 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | (* (Not Available)) | Secondary |
| 122300000X | Dentist | 13692 (Massachusetts) | Primary |
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