Provider Demographics
NPI:1407001423
Name:BOSTON UNIVERSITY
Entity Type:Organization
Organization Name:BOSTON UNIVERSITY
Other - Org Name:SCHOOL OF DENTAL MEDICINE
Other - Org Type:Other Name
Authorized Official - Title/Position:ASSISTANT PROFESSOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:M
Authorized Official - Last Name:CALABRESE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:617-638-5209
Mailing Address - Street 1:100 E NEWTON ST
Mailing Address - Street 2:SUITE 618
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118-2308
Mailing Address - Country:US
Mailing Address - Phone:617-638-5209
Mailing Address - Fax:617-638-5209
Practice Address - Street 1:100 E NEWTON ST
Practice Address - Street 2:SUITE 618
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02118-2308
Practice Address - Country:US
Practice Address - Phone:617-638-5209
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BOSTON UNIVERSITY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-11-18
Last Update Date:2008-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA04-2103547N284300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes284300000XHospitalsSpecial Hospital