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General NPI Number Information
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NPI Number | 1609989235
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Entity Type | Organization
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Legal Business Name | LEWIS WHARF DENTAL ASSOCIATES
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Dates
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Enumeration Date | 08/17/2006
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Last Update Date | 07/30/2008
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Provider Practice Location Address
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Address Line | 28 ATLANTIC AVE. STE. 237
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City | BOSTON
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State | MA
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Zip | 02110
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Country | US
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Telephone | 617-227-4831
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Fax | 617-227-3174
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Provider Business Mailing Address
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Address Line | 28 ATLANTIC AVE. OFFICE 237
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City | BOSTON
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State | MA
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Zip | 02110
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Country | US
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Telephone | 617-227-4831
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Fax | 617-227-3174
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Authorized Official
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Title or Position | OWNER
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Name | DR. WILLIAM L. MANESS
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Credential | DDS
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Telephone | 617-227-4831
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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 | 11614
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License Number State | MA
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