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75 Mount Auburn St Cambridge MA 02138-4960 | |
| (617) 496-9506 | |
| (617) 495-6059 |
| Full Name | |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 75 Mount Auburn St, Cambridge, Massachusetts |
| Authorized Official Name and Position | Kathleen M Cole (DIRECTOR, REVENUE CYCLE MGMT) |
| Authorized Official Contact | 6174969506 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
75 Mount Auburn St Cambridge MA 02138-4960 Ph: (617) 496-9506 | 75 Mount Auburn St Cambridge MA 02138-4960 Ph: (617) 496-9506 |
| NPI Number | 1316116023 |
|---|---|
| Provider Enumeration Date | 02/27/2008 |
| Last Update Date | 07/21/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1316116023 | NPI | - | NPPES |
| X12636 | Other | MA | BLUE SHIELD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (Massachusetts) | Primary |
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