| Back Bay Dental Group Llc | |
|
21 Bay State Rd Boston MA 02215-2101 | |
| (617) 247-9966 | |
| Not Available |
| Full Name | Back Bay Dental Group Llc |
|---|---|
| Speciality | Dentist |
| Location | 21 Bay State Rd, Boston, Massachusetts |
| Authorized Official Name and Position | Richard Miller (PRESIDENT) |
| Authorized Official Contact | 6179216292 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Back Bay Dental Group Llc 21 Bay State Rd Boston MA 02215-2101 Ph: () - | Back Bay Dental Group Llc 21 Bay State Rd Boston MA 02215-2101 Ph: (617) 247-9966 |
| NPI Number | 1063758639 |
|---|---|
| Provider Enumeration Date | 12/29/2012 |
| Last Update Date | 01/03/2013 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1063758639 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | (* (Not Available)) | Primary |
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