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General NPI Number Information
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NPI Number | 1821862871
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Entity Type | Organization
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Legal Business Name | BEDFORD DENTAL LLC
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Dates
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Enumeration Date | 11/09/2023
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Last Update Date | 11/21/2023
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Provider Practice Location Address
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Address Line | 41 NORTH RD STE 107
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City | BEDFORD
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State | MA
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Zip | 01730-1037
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Country | US
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Telephone | 781-275-7153
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Fax |
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Provider Business Mailing Address
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Address Line | 104 PHILIP FARM RD
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City | CONCORD
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State | MA
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Zip | 01742-2712
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Country | US
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Telephone | 617-953-9358
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Fax |
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Authorized Official
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Title or Position | DENTIST/OWNER
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Name | LEONID KHARIN
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Credential |
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Telephone | 617-953-9358
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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