Healthcare Provider Details

I. General information

NPI: 1598818122
Provider Name (Legal Business Name): TRUSTEES OF BOSTON UNIVERSITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2007
Last Update Date: 12/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

930 COMMONWEALTH AVE
BOSTON MA
02215-1274
US

IV. Provider business mailing address

930 COMMONWEALTH AVE
BOSTON MA
02215-1274
US

V. Phone/Fax

Practice location:
  • Phone: 617-358-1000
  • Fax: 617-358-1010
Mailing address:
  • Phone: 617-358-1000
  • Fax: 617-358-1010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number4954
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number4954
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number4954
License Number StateMA
# 4
Primary TaxonomyN
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number4954
License Number StateMA
# 5
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number4954
License Number StateMA
# 6
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number4954
License Number StateMA
# 7
Primary TaxonomyN
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number4954
License Number StateMA
# 8
Primary TaxonomyN
Taxonomy Code126800000X
TaxonomyDental Assistant
License Number4954
License Number StateMA
# 9
Primary TaxonomyN
Taxonomy Code126900000X
TaxonomyDental Laboratory Technician
License Number4954
License Number StateMA
# 10
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number4954
License Number StateMA

VIII. Authorized Official

Name: DR. JEFFREY W HUTTER
Title or Position: PROFESSOR AND DEAN
Credential: DMD, MED
Phone: 617-638-4780