Healthcare Provider Details

I. General information

NPI: 1740866342
Provider Name (Legal Business Name): BOSTON CENTER FOR ORAL HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2021
Last Update Date: 03/24/2021
Certification Date: 03/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 COMMONWEALTH AVE STE 104B
BOSTON MA
02215-2813
US

IV. Provider business mailing address

400 COMMONWEALTH AVE STE 104B
BOSTON MA
02215-2813
US

V. Phone/Fax

Practice location:
  • Phone: 617-536-4620
  • Fax: 617-536-3872
Mailing address:
  • Phone: 617-536-4620
  • Fax: 617-536-3872

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173F00000X
TaxonomySleep Specialist (PhD)
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier16477
Identifier TypeOTHER
Identifier StateMA
Identifier IssuerDENTAL LICENSE NUMBER

VIII. Authorized Official

Name: MR. LUKE AMNOTT
Title or Position: OFFICE MANAGER
Credential:
Phone: 617-536-4620