FRESH POND DENTAL LLC NPI 1134496904

NPI Information

NPI: 1134496904
Provider Name: FRESH POND DENTAL LLC
Classification: Clinic/Center - 261QD0000X
Entity Type: Organization

Specialization: Dental

Address:
180 ALEWIFE BROOK PKWY
CAMBRIDGE, MA
ZIP 02138
Phone: (617) 547-0700
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FRESH POND DENTAL LLC is a dental clinic center in Cambridge, MA. FRESH POND DENTAL LLC NPI is 1134496904. The provider is registered as an organization entity type.

The provider's business location address is:

180 ALEWIFE BROOK PKWY
CAMBRIDGE, MA
ZIP 02138-102
Phone: (617) 547-0700

The provider's authorized official is Andrey Mazo .
The authorized official title is Owner and has the following contact phone number (617) 285-6414.

The enumeration date for this NPI number is 11/22/2011 and was last updated on 11/22/2011.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QD0000X	Clinic/Center	Dental	18643	MASSACHUSETTS	Yes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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