Provider Demographics
NPI:1326419524
Name:BROOKLINE DENTAL ASSOCIATES LLC
Entity Type:Organization
Organization Name:BROOKLINE DENTAL ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROSTHODONTIST
Authorized Official - Prefix:
Authorized Official - First Name:NITIN
Authorized Official - Middle Name:B
Authorized Official - Last Name:KHANKARI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, MS
Authorized Official - Phone:617-331-1858
Mailing Address - Street 1:209 HARVARD ST STE 502
Mailing Address - Street 2:
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02446-5005
Mailing Address - Country:US
Mailing Address - Phone:617-731-1200
Mailing Address - Fax:617-731-1215
Practice Address - Street 1:209 HARVARD ST STE 502
Practice Address - Street 2:
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02446-5005
Practice Address - Country:US
Practice Address - Phone:617-731-1200
Practice Address - Fax:617-731-1215
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-14
Last Update Date:2015-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN18555051223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0700XDental ProvidersDentistProsthodonticsGroup - Single Specialty