Healthcare Provider Details

I. General information

NPI: 1356459895
Provider Name (Legal Business Name): GAIL LINK MCCAUSLAND DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: GAIL ANN LINK DMD

II. Dates (important events)

Enumeration Date: 08/25/2006
Last Update Date: 03/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 EAST NEWTON STREET G-02 BOSTON UNIVERSITY HENRY M GOLDMAN SCHOOL OF DENTAL MEDI
BOSTON MA
02118
US

IV. Provider business mailing address

100 EAST NEWTON STREET G-02 BOSTON UNIVERSITY HENRY M GOLDMAN SCHOOL OF DENTAL MEDI
BOSTON MA
02118
US

V. Phone/Fax

Practice location:
  • Phone: 781-729-9390
  • Fax: 781-729-6792
Mailing address:
  • Phone: 617-638-4705
  • Fax: 617-638-4713

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number19240
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number019240
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: