Healthcare Provider Details

I. General information

NPI: 1912090887
Provider Name (Legal Business Name): DENTAL ASSOCIATES OF NEW ENGLAND
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 BROOKLINE PL
BROOKLINE MA
02445-7230
US

IV. Provider business mailing address

2 BROOKLINE PL
BROOKLINE MA
02445-7230
US

V. Phone/Fax

Practice location:
  • Phone: 617-738-3500
  • Fax: 617-738-6037
Mailing address:
  • Phone: 617-738-3500
  • Fax: 617-738-6037

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number14230
License Number StateMA

VIII. Authorized Official

Name: DR. JOHN DAMIAN MEOLA JR.
Title or Position: PRESIDENT
Credential:
Phone: 617-738-3500