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General NPI Number Information
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NPI Number | 1235306002
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Entity Type | Organization
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Legal Business Name | BOYLSTON DENTAL ASSOCIATES
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Dates
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Enumeration Date | 05/12/2008
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Last Update Date | 05/12/2008
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Provider Practice Location Address
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Address Line | 17 MAIN ST
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City | BOYLSTON
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State | MA
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Zip | 01505-1948
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Country | US
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Telephone | 508-869-6388
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Fax | 508-869-2910
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Provider Business Mailing Address
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Address Line | 17 MAIN ST
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City | BOYLSTON
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State | MA
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Zip | 01505-1948
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Country | US
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Telephone | 508-869-6388
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Fax | 508-869-2910
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | JOHN F SCANLON
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Credential | DMD
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Telephone | 508-869-6388
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 14415
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License Number State | MA
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