| |
811 Boylston St Ste 3 Boston MA 02116-2679 | |
(617) 267-3993 | |
Not Available |
Full Name | |
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Speciality | Dentist - General Practice |
Location | 811 Boylston St Ste 3, Boston, Massachusetts |
Authorized Official Name and Position | Alicia Laclair (CLINICAL SYSTEMS DIRECTOR) |
Authorized Official Contact | 5082816464 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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257 Turnpike Rd Ste 110 Southborough MA 01772-1791 Ph: (508) 281-6464 | 811 Boylston St Ste 3 Boston MA 02116-2679 Ph: (617) 267-3993 |
NPI Number | 1265164081 |
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Provider Enumeration Date | 06/29/2022 |
Last Update Date | 06/29/2022 |
Identifier | Type | State | Issuer |
---|---|---|---|
1265164081 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
122300000X | Dentist | (* (Not Available)) | Secondary |
1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |
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