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General NPI Number Information
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NPI Number | 1033233713
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Entity Type | Organization
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Legal Business Name | LONGWOOD DENTAL GROUP
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Dates
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Enumeration Date | 03/19/2007
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 1842 BEACON ST
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City | BROOKLINE
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State | MA
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Zip | 02445-1930
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Country | US
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Telephone | 617-566-5445
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Fax | 617-730-8482
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Provider Business Mailing Address
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Address Line | 1842 BEACON ST
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City | BROOKLINE
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State | MA
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Zip | 02445-1930
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Country | US
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Telephone | 617-566-5445
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Fax | 617-730-8482
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Authorized Official
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Title or Position | OWNER
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Name | DR. BERDJ KILADJIAN
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Credential | DMD
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Telephone | 617-566-5445
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number |
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License Number State | MA
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Taxonomy #3
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Taxonomy Code | 1223P0106X
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Taxonomy Name | Oral and Maxillofacial Pathology Dentistry
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License Number |
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License Number State | MA
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Taxonomy #4
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number |
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License Number State | MA
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Taxonomy #5
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Taxonomy Code | 1223P0700X
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Taxonomy Name | Prosthodontics
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number |
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License Number State | MA
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Taxonomy #7
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Taxonomy Code | 126800000X
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Taxonomy Name | Dental Assistant
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License Number |
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License Number State | MA
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Taxonomy #8
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Taxonomy Code | 126900000X
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Taxonomy Name | Dental Laboratory Technician
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License Number |
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License Number State | MA
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