Provider Demographics
NPI:1104040757
Name:TRUSTEES OF TUFTS UNIVERSITY
Entity Type:Organization
Organization Name:TRUSTEES OF TUFTS UNIVERSITY
Other - Org Name:TUFTS DENTAL FACILITY GLAVIN
Other - Org Type:Other Name
Authorized Official - Title/Position:ADMINISTRATIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:MORGAN
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:781-899-6020
Mailing Address - Street 1:81 HOPE AVE
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01603-2212
Mailing Address - Country:US
Mailing Address - Phone:508-751-6746
Mailing Address - Fax:508-756-3405
Practice Address - Street 1:81 HOPE AVE
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01603-2212
Practice Address - Country:US
Practice Address - Phone:508-751-6746
Practice Address - Fax:508-756-3405
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA20040261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0272213OtherMASSHEALTH PROVIDER NUMBE