Healthcare Provider Details

I. General information

NPI: 1750720918
Provider Name (Legal Business Name): JASON A BOCH DMD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2013
Last Update Date: 06/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 ANDREW AVE STE 201
WAYLAND MA
01778
US

IV. Provider business mailing address

45 MEADOWBROOK CIR
SUDBURY MA
01776-2641
US

V. Phone/Fax

Practice location:
  • Phone: 508-358-0150
  • Fax: 508-358-0131
Mailing address:
  • Phone: 978-443-2108
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number19000
License Number StateMA

VIII. Authorized Official

Name: DR. JASON A BOCH
Title or Position: MEMBER
Credential: DMD
Phone: 508-358-0150