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37 Newbury St Ste 3 Boston MA 02116-3428 | |
| (617) 426-5549 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 37 Newbury St Ste 3, Boston, Massachusetts |
| Authorized Official Name and Position | Kristen Dority (PRESIDENT) |
| Authorized Official Contact | 6174265549 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
37 Newbury St Ste 3 Boston MA 02116-3428 Ph: (617) 416-4685 | 37 Newbury St Ste 3 Boston MA 02116-3428 Ph: (617) 426-5549 |
| NPI Number | 1447752563 |
|---|---|
| Provider Enumeration Date | 03/05/2018 |
| Last Update Date | 03/05/2018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1447752563 | NPI | - | NPPES |
| 1518039973 | Other | MA | DENTAL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | DN20595 (Massachusetts) | Primary |
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