Healthcare Provider Details

I. General information

NPI: 1881091502
Provider Name (Legal Business Name): BEDFORD PERIODONTAL & IMPLANT CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/24/2014
Last Update Date: 11/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 NORTH RD SUITE 225
BEDFORD MA
01730-1075
US

IV. Provider business mailing address

55 NORTH RD SUITE 225
BEDFORD MA
01730-1075
US

V. Phone/Fax

Practice location:
  • Phone: 781-275-5766
  • Fax:
Mailing address:
  • Phone: 781-275-5766
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: CYNTHIA TSAMTSOURIS
Title or Position: OWNER
Credential: DMD
Phone: 781-275-5766