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General NPI Number Information
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NPI Number | 1497977177
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Entity Type | Organization
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Legal Business Name | FORSYTH DENTAL INFIRMARY FOR CHILDREN
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Dates
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Enumeration Date | 05/03/2007
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Last Update Date | 12/09/2008
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Provider Practice Location Address
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Address Line | 140 FENWAY
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City | BOSTON
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State | MA
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Zip | 02115
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Country | US
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Telephone | 617-262-5200
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Fax | 617-262-4021
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Provider Business Mailing Address
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Address Line | 140 FENWAY
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City | BOSTON
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State | MA
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Zip | 02115
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Country | US
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Telephone | 617-262-5200
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Fax | 617-262-4021
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Authorized Official
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Title or Position | DIRECTOR CENTER FOR EVIDENCE BASED
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Name | DR. RICHARD NIEDERMAN
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Credential | DDS
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Telephone | 617-262-5200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 13692
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License Number State | MA
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