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36 Chauncy St Boston MA 02111-2209 | |
| (617) 338-5000 | |
| (617) 338-1039 |
| Full Name | |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 36 Chauncy St, Boston, Massachusetts |
| Authorized Official Name and Position | Fred G. Boustany (PRESIDENT) |
| Authorized Official Contact | 6173385000 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
36 Chauncy St Boston MA 02111-2209 Ph: (617) 338-5000 | 36 Chauncy St Boston MA 02111-2209 Ph: (617) 338-5000 |
| NPI Number | 1710013172 |
|---|---|
| Provider Enumeration Date | 02/27/2007 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1710013172 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 15733 (Massachusetts) | Primary |
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