| Mount Ida College Dental Center | |
|
777 Dedham St Newton MA 02459-3323 | |
| (617) 928-7360 | |
| (617) 928-7030 |
| Full Name | Mount Ida College Dental Center |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 777 Dedham St, Newton, Massachusetts |
| Authorized Official Name and Position | Gary Melvin Beckett (SUPERVISING DENTIST) |
| Authorized Official Contact | 6179287360 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Mount Ida College Dental Center 777 Dedham St Newton MA 02459-3323 Ph: (617) 928-7360 | Mount Ida College Dental Center 777 Dedham St Newton MA 02459-3323 Ph: (617) 928-7360 |
| NPI Number | 1902929961 |
|---|---|
| Provider Enumeration Date | 04/06/2007 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1902929961 | NPI | - | NPPES |
| 0297658 | Medicaid | MA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 15111 (Massachusetts) | Primary |
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