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General NPI Number Information
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NPI Number | 1881161644
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Entity Type | Organization
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Legal Business Name | TUFTS DENTAL AND LENNON DENTAL GROUP, LLC
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Dates
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Enumeration Date | 10/30/2018
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Last Update Date | 10/30/2018
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Provider Practice Location Address
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Address Line | 620 MAIN ST
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City | WOBURN
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State | MA
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Zip | 01801-7129
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Country | US
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Telephone | 781-935-1630
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Fax |
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Provider Business Mailing Address
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Address Line | 1 TECHNOLOGY PARK DR STE C
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City | BOURNE
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State | MA
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Zip | 02532-8336
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Country | US
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Telephone | 508-759-2724
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Fax |
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | DR. DAVID A RUSSELL
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Credential | DMD
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Telephone | 508-759-2724
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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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