MEDICARE: TRUSTEES OF TUFTS UNIVERSITY

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	261QD0000X	Dental Clinic/Center	20040	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0272175	OTHER	MA	MASSHEALTH PROVIDER NUMBE

General Provider Information

NPI Number	:	1871719104
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRUSTEES OF TUFTS UNIVERSITY

Provider Business Mailing Address
First Line	:	TUFTS DENTAL FACILITY FERNALD
Second Line	:	200 TRAPELO ROAD
City	:	WALTHAM
State	:	MA
Zip	:	02452
Country	:	US
Telephone Number	:	781-899-6020
Fax Number	:	781-893-1829

Provider Business Practice Location Address
First Line	:	200 TRAPELO RD
Second Line	:
City	:	WALTHAM
State	:	MA
Zip	:	02452-6332
Country	:	US
Telephone Number	:	781-899-6020
Fax Number	:	781-893-1829

Authorized Official
Title or Position	:	ADMINISTRATIVE DIRECTOR
Name	:	DR. JOHN PATRICK MORGAN JR.
Credential	:
Telephone Number	:	781-899-6020

Provider Enumeration Date	:	04/17/2007
Last Update Date	:	08/22/2020

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