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General NPI Number Information
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NPI Number | 1609210319
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Entity Type | Organization
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Legal Business Name | DENTAL SERVICE OF MASSACHUSETTS, INC.
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Dates
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Enumeration Date | 04/24/2013
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Last Update Date | 04/24/2013
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Provider Practice Location Address
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Address Line | 465 MEDFORD ST
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City | BOSTON
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State | MA
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Zip | 02129-1426
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Country | US
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Telephone | 617-886-1683
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Fax |
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Provider Business Mailing Address
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Address Line | 465 MEDFORD ST
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City | BOSTON
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State | MA
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Zip | 02129-1426
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Country | US
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Telephone | 617-886-1683
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Fax |
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Authorized Official
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Title or Position | PRESIDENT AND CEO
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Name | FAY DONOHUE
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Credential |
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Telephone | 617-886-1410
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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 | MA
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