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General NPI Number Information
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NPI Number | 1952595696
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Entity Type | Organization
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Legal Business Name | T.P.DEAHL D.D.S., P.C.
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Dates
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Enumeration Date | 09/05/2007
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Last Update Date | 09/05/2007
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Provider Practice Location Address
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Address Line | 2286 MASSACHUSETTS AVE
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City | CAMBRIDGE
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State | MA
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Zip | 02140-1812
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Country | US
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Telephone | 617-868-4046
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Fax | 617-868-5375
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Provider Business Mailing Address
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Address Line | 2286 MASSACHSUETTS AVE
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City | CAMBRIDGE
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State | MA
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Zip | 02140
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Country | US
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Telephone | 617-868-4046
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Fax | 617-868-5375
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. TIMOTHY PAUL DEAHL
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Credential | D.D.S.
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Telephone | 617-868-4046
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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 | 16574
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License Number State | MA
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