Provider Demographics
NPI:1225303811
Name:NEWTON CORNER DENTAL CARE
Entity Type:Organization
Organization Name:NEWTON CORNER DENTAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:GRETCHEN
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:ANJOMI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:617-312-0648
Mailing Address - Street 1:8 LEXINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:CHARLESTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02129-3102
Mailing Address - Country:US
Mailing Address - Phone:617-312-0648
Mailing Address - Fax:
Practice Address - Street 1:313 WASHINGTON ST
Practice Address - Street 2:SUITE 100
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02458-1626
Practice Address - Country:US
Practice Address - Phone:617-312-0648
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-14
Last Update Date:2012-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAMA20543261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental