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General NPI Number Information
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NPI Number | 1982757506
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Entity Type | Organization
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Legal Business Name | TRUSTEES OF BOSTON UNIVERSITY
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Dates
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Enumeration Date | 01/18/2007
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Last Update Date | 12/01/2016
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Provider Practice Location Address
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Address Line | 100 E NEWTON ST RM G317
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City | BOSTON
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State | MA
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Zip | 02118-2308
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Country | US
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Telephone | 617-638-5932
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Fax | 617-638-4490
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Provider Business Mailing Address
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Address Line | 100 E NEWTON ST RM G317
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City | BOSTON
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State | MA
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Zip | 02118-2308
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Country | US
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Telephone | 617-638-5932
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Fax | 617-638-4490
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Authorized Official
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Title or Position | SENIOR VP, CFO & TREASURER
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Name | MR. MARTIN HOWARD
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Credential |
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Telephone | 617-353-2290
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 4954
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | 4954
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License Number State | MA
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Taxonomy #3
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Taxonomy Code | 1223P0106X
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Taxonomy Name | Oral and Maxillofacial Pathology Dentistry
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License Number | 4954
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License Number State | MA
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Taxonomy #4
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 4954
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License Number State | MA
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Taxonomy #5
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 4954
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License Number State | MA
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Taxonomy #6
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Taxonomy Code | 1223P0700X
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Taxonomy Name | Prosthodontics
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License Number | 4954
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License Number State | MA
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Taxonomy #7
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 4954
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License Number State | MA
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Taxonomy #8
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 4954
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License Number State | MA
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Taxonomy #9
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Taxonomy Code | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | 4954
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License Number State | MA
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Taxonomy #10
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 4954
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License Number State | MA
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