Healthcare Provider Details

I. General information

NPI: 1477099018
Provider Name (Legal Business Name): ADELA AGOLLI TARSHI DMD P.C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/06/2017
Last Update Date: 01/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 CAMBRIDGE ST
BURLINGTON MA
01803-4625
US

IV. Provider business mailing address

11 CAMBRIDGE ST
BURLINGTON MA
01803-4625
US

V. Phone/Fax

Practice location:
  • Phone: 781-229-1111
  • Fax:
Mailing address:
  • Phone: 781-229-1111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License NumberDN22163
License Number StateMA

VIII. Authorized Official

Name: DR. ADELA AGOLLI
Title or Position: ENDODONTIST
Credential: DMD
Phone: 617-523-4555