Provider Demographics
NPI:1073756060
Name:PROGRESSIVE DENTISTRY
Entity Type:Organization
Organization Name:PROGRESSIVE DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SANDHYA
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:617-776-5550
Mailing Address - Street 1:1170 BEACON ST
Mailing Address - Street 2:SUITE 110
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02446-3963
Mailing Address - Country:US
Mailing Address - Phone:617-383-6593
Mailing Address - Fax:617-383-6595
Practice Address - Street 1:1170 BEACON ST
Practice Address - Street 2:SUITE 110
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02446-3963
Practice Address - Country:US
Practice Address - Phone:617-383-6593
Practice Address - Fax:617-383-6595
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-07
Last Update Date:2009-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA19257261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental