Healthcare Provider Details

I. General information

NPI: 1013587146
Provider Name (Legal Business Name): BLAISE C. ECKERT, DDS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2021
Last Update Date: 06/30/2021
Certification Date: 06/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

68 LEONARD ST STE 301
BELMONT MA
02478-2574
US

IV. Provider business mailing address

68 LEONARD ST STE 301
BELMONT MA
02478-2574
US

V. Phone/Fax

Practice location:
  • Phone: 617-484-5266
  • Fax: 617-484-2739
Mailing address:
  • Phone: 617-484-5266
  • Fax: 617-484-2739

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State

VIII. Authorized Official

Name: DR. BLAISE C ECKERT
Title or Position: OWNER/ORAL & MAXILLOFACIAL SURGEON
Credential: DDS
Phone: 617-484-5266