| Northgate Dental Center | |
|
603 Broadway Revere MA 02151-3045 | |
| (781) 289-3600 | |
| Not Available |
| Full Name | Northgate Dental Center |
|---|---|
| Speciality | Dentist - Endodontics |
| Location | 603 Broadway, Revere, Massachusetts |
| Authorized Official Name and Position | Fardad Mobed (OWNER) |
| Authorized Official Contact | 7812893600 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Northgate Dental Center 603 Broadway Revere MA 02151-3045 Ph: (781) 289-3600 | Northgate Dental Center 603 Broadway Revere MA 02151-3045 Ph: (781) 289-3600 |
| NPI Number | 1912166141 |
|---|---|
| Provider Enumeration Date | 06/03/2008 |
| Last Update Date | 06/03/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1912166141 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223E0200X | Dentist - Endodontics | 18187 (Massachusetts) | Primary |
| 1223G0001X | Dentist - General Practice | 18187 (Massachusetts) | Secondary |
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