Provider Demographics
NPI:1508169830
Name:TRUSTEES OF TUFTS UNIVERSITY
Entity Type:Organization
Organization Name:TRUSTEES OF TUFTS UNIVERSITY
Other - Org Name:TUFTS DENTAL FACILITY TEMPLETON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF CLINICAL OPERATIONS
Authorized Official - Prefix:DR
Authorized Official - First Name:DARREN
Authorized Official - Middle Name:J
Authorized Official - Last Name:DRAG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-899-6020
Mailing Address - Street 1:212 FREIGHT SHED ROAD
Mailing Address - Street 2:
Mailing Address - City:BALDWINVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:01436
Mailing Address - Country:US
Mailing Address - Phone:978-939-2161
Mailing Address - Fax:
Practice Address - Street 1:212 FREIGHT SHED ROAD
Practice Address - Street 2:
Practice Address - City:BALDWINVILLE
Practice Address - State:MA
Practice Address - Zip Code:01436
Practice Address - Country:US
Practice Address - Phone:978-939-2161
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-08
Last Update Date:2010-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA20040261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental