Healthcare Provider Details

I. General information

NPI: 1861931867
Provider Name (Legal Business Name): TUFTS UNIVERSITY SCHOOL OF DENTAL MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2017
Last Update Date: 02/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 KNEELAND ST 3RD FL
BOSTON MA
02111-1527
US

IV. Provider business mailing address

200 HARRISON AVE 2ND FL
BOSTON MA
02111-1836
US

V. Phone/Fax

Practice location:
  • Phone: 617-636-6812
  • Fax:
Mailing address:
  • Phone: 617-636-0451
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0008X
TaxonomyOral and Maxillofacial Radiology Dentistry
License Number
License Number State

VIII. Authorized Official

Name: BETH CONANT
Title or Position: DIR CLINIC FINANCE & ADMINISTRATION
Credential:
Phone: 617-636-6842