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131 Dartmouth St Fl 3 Boston MA 02116-5297 | |
| (617) 535-3305 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Dentist - Orthodontics And Dentofacial Orthopedics |
| Location | 131 Dartmouth St Fl 3, Boston, Massachusetts |
| Authorized Official Name and Position | Casey Lonabocker (VICE PRESIDENT OPERATIONS) |
| Authorized Official Contact | 6175353364 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
131 Dartmouth St Fl 3 Boston MA 02116-5297 Ph: (617) 535-3305 | 131 Dartmouth St Fl 3 Boston MA 02116-5297 Ph: (617) 535-3305 |
| NPI Number | 1740919000 |
|---|---|
| Provider Enumeration Date | 06/09/2022 |
| Last Update Date | 11/20/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1740919000 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223X0400X | Dentist - Orthodontics And Dentofacial Orthopedics | (* (Not Available)) | Primary |
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