Healthcare Provider Details

I. General information

NPI: 1699821116
Provider Name (Legal Business Name): ELENI GAGARI D.M.D., D.M.SC.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/26/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 KNEELAND ST
BOSTON MA
02111-1527
US

IV. Provider business mailing address

1 KNEELAND ST
BOSTON MA
02111-1527
US

V. Phone/Fax

Practice location:
  • Phone: 617-636-6510
  • Fax: 671-636-6780
Mailing address:
  • Phone: 617-636-6510
  • Fax: 671-636-6780

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0106X
TaxonomyOral and Maxillofacial Pathology Dentistry
License Number20971
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: