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188 Longwood Ave Boston MA 02115-5819 | |
| (617) 432-1401 | |
| (617) 432-4258 |
| Full Name | |
|---|---|
| Speciality | Dentist - Oral And Maxillofacial Surgery |
| Location | 188 Longwood Ave, Boston, Massachusetts |
| Authorized Official Name and Position | Robert Bruce Donoff (DEAN) |
| Authorized Official Contact | 6174321401 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
188 Longwood Ave Boston MA 02115-5819 Ph: (617) 432-1401 | 188 Longwood Ave Boston MA 02115-5819 Ph: (617) 432-1401 |
| NPI Number | 1881852713 |
|---|---|
| Provider Enumeration Date | 05/28/2008 |
| Last Update Date | 05/28/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1881852713 | NPI | - | NPPES |
| 0200140 | Medicaid | MA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223S0112X | Dentist - Oral And Maxillofacial Surgery | 37230 (Massachusetts) | Primary |
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