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1 Kneeland St 3rd Fl Boston MA 02111-1527 | |
| (617) 636-6812 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Dentist - Oral And Maxillofacial Radiology |
| Location | 1 Kneeland St, Boston, Massachusetts |
| Authorized Official Name and Position | Beth Conant (DIR CLINIC FINANCE & ADMINISTRATION) |
| Authorized Official Contact | 6176366842 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
200 Harrison Ave 2nd Fl Boston MA 02111-1836 Ph: (617) 636-0451 | 1 Kneeland St 3rd Fl Boston MA 02111-1527 Ph: (617) 636-6812 |
| NPI Number | 1861931867 |
|---|---|
| Provider Enumeration Date | 02/23/2017 |
| Last Update Date | 02/28/2017 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1861931867 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223X0008X | Dentist - Oral And Maxillofacial Radiology | (* (Not Available)) | Primary |
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