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165 Cambridge St Suite 401 Boston MA 02114-2783 | |
| (617) 726-1076 | |
| (617) 724-6681 |
| Full Name | |
|---|---|
| Speciality | Dentist |
| Location | 165 Cambridge St, Boston, Massachusetts |
| Authorized Official Name and Position | Agnes Lau (DIRECTOR, MGH DENTAL GROUP) |
| Authorized Official Contact | 6177261076 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
165 Cambridge St Suite 401 Boston MA 02114-2783 Ph: (617) 726-1076 | 165 Cambridge St Suite 401 Boston MA 02114-2783 Ph: (617) 726-1076 |
| NPI Number | 1265583199 |
|---|---|
| Provider Enumeration Date | 01/16/2007 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1265583199 | NPI | - | NPPES |
| 1364 | Other | MA | DELTA DENTAL SPECIALIST |
| 774 | Other | MA | DELTA DENTAL GROUP NUMBER |
| 9762779 | Medicaid | MA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 16139 (Massachusetts) | Primary |
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