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140 The Fenway Boston MA 02115-3782 | |
| (617) 892-8383 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Dentist |
| Location | 140 The Fenway, Boston, Massachusetts |
| Authorized Official Name and Position | Richard Neiderman (DIRECTOR) |
| Authorized Official Contact | 6178928374 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
140 The Fenway Boston MA 02115-3782 Ph: (617) 892-8383 | 140 The Fenway Boston MA 02115-3782 Ph: (617) 892-8383 |
| NPI Number | 1568609071 |
|---|---|
| Provider Enumeration Date | 01/21/2009 |
| Last Update Date | 01/21/2009 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1568609071 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 10133 (Massachusetts) | Primary |
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