Healthcare Provider Details

I. General information

NPI: 1124173612
Provider Name (Legal Business Name): RICHARD D CARR DDS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

68 NEW EDGERELY ROAD
BOSTON MA
02115
US

IV. Provider business mailing address

68 NEW EDGERELY ROAD
BOSTON MA
02115
US

V. Phone/Fax

Practice location:
  • Phone: 617-262-5880
  • Fax: 617-859-8804
Mailing address:
  • Phone: 617-262-5880
  • Fax: 617-859-8804

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number11712
License Number StateMA

VIII. Authorized Official

Name: RICHARD D CARR
Title or Position: OWNER
Credential: DDS
Phone: 617-262-5880