Provider Demographics
NPI:1285190413
Name:CONCORD FAMILY DENTAL
Entity Type:Organization
Organization Name:CONCORD FAMILY DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MASANEL
Authorized Official - Middle Name:
Authorized Official - Last Name:UVAYDOV
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:646-703-1623
Mailing Address - Street 1:23 BARTLETT AVE
Mailing Address - Street 2:
Mailing Address - City:BELMONT
Mailing Address - State:MA
Mailing Address - Zip Code:02478-1802
Mailing Address - Country:US
Mailing Address - Phone:646-703-1623
Mailing Address - Fax:
Practice Address - Street 1:32 CONCORD ST
Practice Address - Street 2:
Practice Address - City:FRAMINGHAM
Practice Address - State:MA
Practice Address - Zip Code:01702-8302
Practice Address - Country:US
Practice Address - Phone:646-703-1623
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-12
Last Update Date:2019-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental