Healthcare Provider Details

I. General information

NPI: 1063867000
Provider Name (Legal Business Name): CAMBRIDGE ENDODONTIC ASSOCIATES, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2016
Last Update Date: 04/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1692 MASSACHUSETTS AVE
CAMBRIDGE MA
02138-1878
US

IV. Provider business mailing address

1692 MASSACHUSETTS AVE
CAMBRIDGE MA
02138-1878
US

V. Phone/Fax

Practice location:
  • Phone: 617-492-3616
  • Fax: 617-492-8415
Mailing address:
  • Phone: 617-492-3616
  • Fax: 617-492-8415

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. MICHAEL JOSEPH
Title or Position: OWNER/ENDODONTIST
Credential: DMD
Phone: 617-492-3616