MEDICARE: CUMMINS FAMILY DENTAL 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	22207	MA

General Provider Information

NPI Number	:	1194090415
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CUMMINS FAMILY DENTAL PC

Provider Business Mailing Address
First Line	:	166 COLUMBIA RD
Second Line	:
City	:	BOSTON
State	:	MA
Zip	:	02121-3411
Country	:	US
Telephone Number	:	617-445-9880
Fax Number	:	617-445-5746

Provider Business Practice Location Address
First Line	:	166 COLUMBIA RD
Second Line	:
City	:	BOSTON
State	:	MA
Zip	:	02121-3411
Country	:	US
Telephone Number	:	617-445-9880
Fax Number	:	617-445-5746

Authorized Official
Title or Position	:	D.M.D.
Name	:	MICHELLE CUMMINS
Credential	:
Telephone Number	:	617-445-9880

Provider Enumeration Date	:	03/20/2012
Last Update Date	:	03/20/2012

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