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General NPI Number Information
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NPI Number | 1396526745
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Entity Type | Organization
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Legal Business Name | YALE AVENUE FAMILY DENTISTRY PC
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Dates
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Enumeration Date | 10/11/2023
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Last Update Date | 10/14/2025
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Provider Practice Location Address
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Address Line | 39 YALE AVE
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City | WAKEFIELD
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State | MA
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Zip | 01880-2308
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Country | US
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Telephone | 209-232-0021
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Fax |
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Provider Business Mailing Address
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Address Line | 39 YALE AVE
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City | WAKEFIELD
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State | MA
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Zip | 01880-2308
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Country | US
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Telephone | 209-232-0021
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | SETH BOZARTH
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Credential |
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Telephone | 209-232-0021
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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