Healthcare Provider Details

I. General information

NPI: 1316864283
Provider Name (Legal Business Name): COMMONWEALTH DENTAL GROUP PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2026
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 COMMONWEALTH AVE STE 3
BOSTON MA
02215-2813
US

IV. Provider business mailing address

22 OLD STOW RD
CONCORD MA
01742-2827
US

V. Phone/Fax

Practice location:
  • Phone: 718-344-3648
  • Fax:
Mailing address:
  • Phone: 718-344-3648
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number
License Number State

VIII. Authorized Official

Name: DR. SHIRLEY AUSTIN
Title or Position: DENTIST
Credential: DMD
Phone: 718-344-3648