Healthcare Provider Details

I. General information

NPI: 1770324238
Provider Name (Legal Business Name): BRENDAN TEEBAGY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2024
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

714 BEDFORD ST
ABINGTON MA
02351-1783
US

IV. Provider business mailing address

714 BEDFORD ST
ABINGTON MA
02351-1783
US

V. Phone/Fax

Practice location:
  • Phone: 781-878-0001
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN10000506
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: