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General NPI Number Information
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NPI Number | 1740146349
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Entity Type | Organization
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Legal Business Name | WABAN PEDIATRIC DENTISTRY, PC
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Dates
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Enumeration Date | 12/29/2025
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Last Update Date | 12/29/2025
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Provider Practice Location Address
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Address Line | 1180 BEACON ST
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City | NEWTON
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State | MA
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Zip | 02461-1103
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Country | US
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Telephone | 617-527-6061
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Fax |
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Provider Business Mailing Address
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Address Line | 1180 BEACON ST
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City | NEWTON
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State | MA
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Zip | 02461-1103
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Country | US
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Telephone | 617-527-6061
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Fax |
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Authorized Official
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Title or Position | OPERATIONS
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Name | BRIAN GAFF
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Credential |
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Telephone | 339-499-8147
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State |
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