MEDICARE: ASHLEY TOBACK

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	1223P0300X	Periodontics	390200000X	MA

General Provider Information

NPI Number	:	1184557720
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASHLEY TOBACK

Provider Business Mailing Address
First Line	:	188 LONGWOOD AVE
Second Line	:
City	:	BOSTON
State	:	MA
Zip	:	02115-5819
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	188 LONGWOOD AVE
Second Line	:
City	:	BOSTON
State	:	MA
Zip	:	02115-5819
Country	:	US
Telephone Number	:	617-432-1434
Fax Number	:

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

Provider Enumeration Date	:	06/04/2026
Last Update Date	:	06/04/2026

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Directions to “ ASHLEY TOBACK ” Practice Location

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