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General NPI Number Information
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NPI Number | 1487717765
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Entity Type | Individual
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Provider Name | MATTHEW DAVID LANN D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 12/18/2006
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Last Update Date | 12/22/2010
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Provider Practice Location Address
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Address Line | 60 ADAMS ST
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City | BRAINTREE
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State | MA
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Zip | 02184-1907
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Country | US
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Telephone | 781-843-0660
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Fax |
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Provider Business Mailing Address
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Address Line | 5 HARWICH LN
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City | ANDOVER
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State | MA
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Zip | 01810-5043
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Country | US
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Telephone | 617-833-5339
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 20025
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License Number State | MA
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