Provider Demographics
NPI:1134458094
Name:GERALD S. FINE, D.D.S.
Entity Type:Organization
Organization Name:GERALD S. FINE, D.D.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:STEPHEN
Authorized Official - Last Name:FINE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:617-731-6060
Mailing Address - Street 1:1223 BEACON ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02446-5302
Mailing Address - Country:US
Mailing Address - Phone:617-731-6060
Mailing Address - Fax:617-975-1990
Practice Address - Street 1:1223 BEACON ST
Practice Address - Street 2:
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02446-5302
Practice Address - Country:US
Practice Address - Phone:617-731-6060
Practice Address - Fax:617-975-1990
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-23
Last Update Date:2009-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAT572060Medicare UPIN