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General NPI Number Information
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NPI Number | 1619583168
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Entity Type | Organization
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Legal Business Name | NEWTON WELLESLEY DENTAL GROUP LLC
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Dates
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Enumeration Date | 09/21/2020
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Last Update Date | 09/21/2020
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Provider Practice Location Address
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Address Line | 447 CENTRE STREET SAME
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City | NEWTON
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State | MA
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Zip | 02458
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Country | US
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Telephone | 617-244-4133
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Fax |
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Provider Business Mailing Address
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Address Line | 447 CENTRE STREET SAME
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City | NEWTON
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State | MA
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Zip | 02458
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Country | US
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Telephone | 617-244-4133
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Fax |
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Authorized Official
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Title or Position | CREDITING SPECIALIST
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Name | LORRAINE E MATHEUS
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Credential |
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Telephone | 781-567-0457
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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