| Moody Street Dental | |
|
509 Moody Street Waltham MA 02453 | |
| (781) 894-0889 | |
| (781) 891-6857 |
| Full Name | Moody Street Dental |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 509 Moody Street, Waltham, Massachusetts |
| Authorized Official Name and Position | Mikhail Shlkinu (DENTIST OWNER) |
| Authorized Official Contact | 7818940889 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Moody Street Dental 509 Moody Street Waltham MA 02453 Ph: (781) 894-0889 | Moody Street Dental 509 Moody Street Waltham MA 02453 Ph: (781) 894-0889 |
| NPI Number | 1356563035 |
|---|---|
| Provider Enumeration Date | 05/03/2007 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1356563035 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 20431 (Massachusetts) | Primary |
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