Healthcare Provider Details

I. General information

NPI: 1942131115
Provider Name (Legal Business Name): DEDHAM MODERN DENTISTRY, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2026
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

727 PROVIDENCE HWY
DEDHAM MA
02026-6832
US

IV. Provider business mailing address

PO BOX 660041
DALLAS TX
75266-0041
US

V. Phone/Fax

Practice location:
  • Phone: 339-227-6255
  • Fax: 339-204-0004
Mailing address:
  • Phone: 714-845-8701
  • Fax: 303-952-0892

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DYLAN J WEBER
Title or Position: OWNER
Credential: DDS
Phone: 339-227-6255