Healthcare Provider Details

I. General information

NPI: 1639183841
Provider Name (Legal Business Name): EDWARD L. LECHTENBERG DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2353 MASSACHUSETTS AVE
CAMBRIDGE MA
02140-1252
US

IV. Provider business mailing address

2353 MASSACHUSETTS AVE
CAMBRIDGE MA
02140-1252
US

V. Phone/Fax

Practice location:
  • Phone: 617-492-8700
  • Fax: 617-492-0698
Mailing address:
  • Phone: 617-492-8700
  • Fax: 617-492-0698

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number10823
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: