Provider Demographics
NPI:1164690707
Name:NEWTON DENTAL GROUP
Entity Type:Organization
Organization Name:NEWTON DENTAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SHIRIN
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAHRIAR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:617-332-3100
Mailing Address - Street 1:290 CENTRE ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02458-1640
Mailing Address - Country:US
Mailing Address - Phone:617-332-3100
Mailing Address - Fax:617-332-5607
Practice Address - Street 1:290 CENTRE ST
Practice Address - Street 2:SUITE 201
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02458-1640
Practice Address - Country:US
Practice Address - Phone:617-332-3100
Practice Address - Fax:617-332-5607
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-18
Last Update Date:2008-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA186821223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty