Healthcare Provider Details

I. General information

NPI: 1942218706
Provider Name (Legal Business Name): BOSTON ENDODONTICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 LONGFELLOW PL STE 205
BOSTON MA
02114-2839
US

IV. Provider business mailing address

50 SALEM ST BLDG A
LYNNFIELD MA
01940-2622
US

V. Phone/Fax

Practice location:
  • Phone: 617-742-3525
  • Fax: 617-742-6911
Mailing address:
  • Phone: 781-245-8828
  • Fax: 781-224-1158

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number15626
License Number StateMA

VIII. Authorized Official

Name: DR. TIMOTHY MARK GABE
Title or Position: PRESIDENT
Credential: DMD
Phone: 781-245-8828