MEDICARE: DR. DONNA L MAGER DDS, DMSC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	19259	MA

General Provider Information

NPI Number	:	1073698411
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DONNA L MAGER DDS, DMSC

Provider Business Mailing Address
First Line	:	85 E INDIA ROW
Second Line	:	36B
City	:	BOSTON
State	:	MA
Zip	:	02110-3320
Country	:	US
Telephone Number	:	617-557-0191
Fax Number	:	617-573-9521

Provider Business Practice Location Address
First Line	:	85 E INDIA ROW
Second Line	:	36B
City	:	BOSTON
State	:	MA
Zip	:	02110-3320
Country	:	US
Telephone Number	:	617-557-0191
Fax Number	:	617-573-9521

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/26/2006
Last Update Date	:	07/08/2007

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