Healthcare Provider Details

I. General information

NPI: 1548290653
Provider Name (Legal Business Name): ROBERT EDWARD GARBER DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 CONGRESS ST SUITE 3-D
QUINCY MA
02169-0908
US

IV. Provider business mailing address

500 CONGRESS ST SUITE 3-D
QUINCY MA
02169-0908
US

V. Phone/Fax

Practice location:
  • Phone: 617-773-9900
  • Fax: 617-773-3477
Mailing address:
  • Phone: 617-773-9900
  • Fax: 617-773-3477

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number14878
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: