Provider Demographics
NPI:1093993503
Name:BOSTON UNIVERSITY'S DEPARTMENT OF ORAL AND MAXILOFACIAL PATHOLOGY
Entity Type:Organization
Organization Name:BOSTON UNIVERSITY'S DEPARTMENT OF ORAL AND MAXILOFACIAL PATHOLOGY
Other - Org Name:BU ORAL AND MAXILOFACIAL PATHOLOGY
Other - Org Type:Other Name
Authorized Official - Title/Position:DEAN AD INTERIM
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:W
Authorized Official - Last Name:HUTTER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, MED
Authorized Official - Phone:617-638-4780
Mailing Address - Street 1:PO BOX 1167
Mailing Address - Street 2:GOLDTHWAIT ASSOC C/O BU ORAL AND MAXILOFACIAL PATHOLOGY
Mailing Address - City:MARBLEHEAD
Mailing Address - State:MA
Mailing Address - Zip Code:01945
Mailing Address - Country:US
Mailing Address - Phone:781-631-8210
Mailing Address - Fax:781-639-2103
Practice Address - Street 1:100 E NEWTON ST
Practice Address - Street 2:RM G-04
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02118-2308
Practice Address - Country:US
Practice Address - Phone:617-638-4775
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TRUSTEES OF BOSTON UNIVERSITY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-02-06
Last Update Date:2008-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA49541223P0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0106XDental ProvidersDentistOral and Maxillofacial PathologyGroup - Single Specialty