Provider Demographics
NPI:1326340068
Name:MASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH
Entity Type:Organization
Organization Name:MASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH
Other - Org Name:OFFICE OF ORAL HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:
Authorized Official - Last Name:WEISBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-624-5260
Mailing Address - Street 1:250 WASHINGTON ST
Mailing Address - Street 2:5TH FLOOR
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02108-4603
Mailing Address - Country:US
Mailing Address - Phone:617-624-6074
Mailing Address - Fax:617-624-6062
Practice Address - Street 1:250 WASHINGTON ST
Practice Address - Street 2:5TH FLOOR
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02108-4603
Practice Address - Country:US
Practice Address - Phone:617-624-6074
Practice Address - Fax:617-624-6062
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COMMONWEALTH OF MASSACHUSETTS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-12-01
Last Update Date:2010-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare