Healthcare Provider Details

I. General information

NPI: 1376251256
Provider Name (Legal Business Name): ALISTAIR DAVID VARIDEL MS, MBBS, BDSC,
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2022
Last Update Date: 11/09/2022
Certification Date: 11/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BOSTON CHILDREN'S HOSPITAL 300 LONGWOOD AVENUE
BOSTON MA
02115
US

IV. Provider business mailing address

247 KENT ST
BROOKLINE MA
02446-5400
US

V. Phone/Fax

Practice location:
  • Phone: 857-218-8891
  • Fax:
Mailing address:
  • Phone: 857-218-8891
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDL15178
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: