| Nedg - Back Bay Pllc | |
|
811 Boylston St Ste 3 Boston MA 02116-2679 | |
| (617) 267-3993 | |
| Not Available |
| Full Name | Nedg - Back Bay Pllc |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 811 Boylston St Ste 3, Boston, Massachusetts |
| Authorized Official Name and Position | Alicia Laclair (CLINICAL SYSTEMS DIRECTOR) |
| Authorized Official Contact | 5082816464 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Nedg - Back Bay Pllc 257 Turnpike Rd Ste 110 Southborough MA 01772-1791 Ph: (508) 281-6464 | Nedg - Back Bay Pllc 811 Boylston St Ste 3 Boston MA 02116-2679 Ph: (617) 267-3993 |
| NPI Number | 1265164081 |
|---|---|
| Provider Enumeration Date | 06/29/2022 |
| Last Update Date | 06/29/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1265164081 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | (* (Not Available)) | Secondary |
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |
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