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396 Commonwealth Ave Boston MA 02215-2823 | |
| (617) 536-7720 | |
| (617) 536-8290 |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 396 Commonwealth Ave, Boston, Massachusetts |
| Authorized Official Name and Position | Irina Deresh (PRESIDENT) |
| Authorized Official Contact | 6175367720 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
396 Commonwealth Ave Boston MA 02215-2823 Ph: (617) 536-7720 | 396 Commonwealth Ave Boston MA 02215-2823 Ph: (617) 536-7720 |
| NPI Number | 1821274044 |
|---|---|
| Provider Enumeration Date | 01/17/2008 |
| Last Update Date | 01/17/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1821274044 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | 17846 (Massachusetts) | Primary |
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