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General NPI Number Information
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NPI Number | 1255608048
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Entity Type | Organization
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Legal Business Name | CHILDREN'S HOSPITAL
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Dates
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Enumeration Date | 11/21/2011
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Last Update Date | 11/21/2011
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Provider Practice Location Address
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Address Line | 11 E MILTON RD APT 2
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City | BROOKLINE
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State | MA
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Zip | 02445-6738
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Country | US
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Telephone | 508-333-4331
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Fax |
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Provider Business Mailing Address
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Address Line | 11 E MILTON RD APT 2
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City | BROOKLINE
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State | MA
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Zip | 02445-6738
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Country | US
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Telephone | 508-333-4331
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Fax |
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Authorized Official
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Title or Position | DENTAL RESIDENT
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Name | DR. BRANDON DAVID GRUNES
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Credential | DMD
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Telephone | 617-355-4426
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 282NC2000X
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Taxonomy Name | Children's Hospital
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License Number | S17991895
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License Number State | MA
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