MEDICARE: BELLINGHAM DENTAL ARTS, PC

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	DN1855046	MA

General Provider Information

NPI Number	:	1144661489
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BELLINGHAM DENTAL ARTS, PC

Provider Business Mailing Address
First Line	:	86 EVERGREEN WAY
Second Line	:
City	:	BELMONT
State	:	MA
Zip	:	02478-2130
Country	:	US
Telephone Number	:	617-484-3853
Fax Number	:

Provider Business Practice Location Address
First Line	:	27 MENDON ST
Second Line	:
City	:	BELLINGHAM
State	:	MA
Zip	:	02019-1555
Country	:	US
Telephone Number	:	508-966-3000
Fax Number	:

Authorized Official
Title or Position	:	DENTIST
Name	:	DR. ERNEST AGAJANYAN
Credential	:	DMD
Telephone Number	:	508-966-3000

Provider Enumeration Date	:	07/15/2013
Last Update Date	:	08/08/2013

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