Healthcare Provider Details

I. General information

NPI: 1952334344
Provider Name (Legal Business Name): NOAH I ZAGER D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

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

III. Provider practice location address

25 BOYLSTON ST
CHESTNUT HILL MA
02467-1715
US

IV. Provider business mailing address

25 BOYLSTON ST
CHESTNUT HILL MA
02467-1715
US

V. Phone/Fax

Practice location:
  • Phone: 617-734-5550
  • Fax:
Mailing address:
  • Phone: 617-734-5550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number10515
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: