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General NPI Number Information
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NPI Number | 1962323733
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Entity Type | Organization
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Legal Business Name | WAVERLY ENDODONTICS GROUP LLC
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Dates
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Enumeration Date | 07/24/2026
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Last Update Date | 07/24/2026
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Provider Practice Location Address
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Address Line | 800 BOYLSTON ST FL 2
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City | BOSTON
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State | MA
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Zip | 02199-8081
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Country | US
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Telephone | 617-841-8436
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Fax |
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Provider Business Mailing Address
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Address Line | 45 1ST AVE APT 4
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City | BOSTON
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State | MA
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Zip | 02129-4560
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Country | US
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Telephone | 617-955-3331
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Fax |
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Authorized Official
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Title or Position | ENDODONTIST
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Name | GARRETT WAVERLY WINGROVE
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Credential | DMD, CAGS, MSD
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Telephone | 617-955-3331
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number |
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License Number State |
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