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General NPI Number Information
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NPI Number | 1225303811
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Entity Type | Organization
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Legal Business Name | NEWTON CORNER DENTAL CARE
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Dates
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Enumeration Date | 03/14/2012
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Last Update Date | 03/14/2012
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Provider Practice Location Address
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Address Line | 313 WASHINGTON ST SUITE 100
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City | NEWTON
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State | MA
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Zip | 02458-1626
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Country | US
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Telephone | 617-312-0648
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Fax |
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Provider Business Mailing Address
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Address Line | 8 LEXINGTON AVE
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City | CHARLESTOWN
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State | MA
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Zip | 02129-3102
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Country | US
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Telephone | 617-312-0648
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | DR. GRETCHEN ANN ANJOMI
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Credential | D.M.D.
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Telephone | 617-312-0648
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | MA20543
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License Number State | MA
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