| Cdg Back Bay Llc | |
|
400 Commonwealth Ave 3rd Floor Boston MA 02215 | |
| (617) 266-8770 | |
| (617) 266-9530 |
| Full Name | Cdg Back Bay Llc |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 400 Commonwealth Ave 3rd Floor, Boston, Massachusetts |
| Authorized Official Name and Position | Christy Lynette Lukasavage (DIRECTOR OF OPERATIONS) |
| Authorized Official Contact | 6172668770 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Cdg Back Bay Llc 400 Commonwealth Ave 3rd Floor Boston MA 02215 Ph: (617) 266-8770 | Cdg Back Bay Llc 400 Commonwealth Ave 3rd Floor Boston MA 02215 Ph: (617) 266-8770 |
| NPI Number | 1114533866 |
|---|---|
| Provider Enumeration Date | 09/18/2020 |
| Last Update Date | 09/18/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1114533866 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Primary |
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