MEDICARE: DR. ROGER B GALBURT D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223P0700X	Prosthodontics	12854	MA

General Provider Information

NPI Number	:	1154351047
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROGER B GALBURT D.D.S.

Provider Business Mailing Address
First Line	:	1 KNEELAND ST
Second Line	:
City	:	BOSTON
State	:	MA
Zip	:	02111-1527
Country	:	US
Telephone Number	:	617-636-0888
Fax Number	:

Provider Business Practice Location Address
First Line	:	1 KNEELAND ST
Second Line	:
City	:	BOSTON
State	:	MA
Zip	:	02111-1527
Country	:	US
Telephone Number	:	617-636-0888
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/04/2006
Last Update Date	:	11/05/2015

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