Provider Demographics
NPI:1518023332
Name:FRAMINGHAM DENTAL GROUP
Entity Type:Organization
Organization Name:FRAMINGHAM DENTAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:STEPHEN
Authorized Official - Last Name:TUTIN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:508-872-0041
Mailing Address - Street 1:1671 WORCESTER ROAD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:FRAMINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01701
Mailing Address - Country:US
Mailing Address - Phone:508-872-0041
Mailing Address - Fax:508-879-7482
Practice Address - Street 1:1671 WORCESTER ROAD
Practice Address - Street 2:SUITE 103
Practice Address - City:FRAMINGHAM
Practice Address - State:MA
Practice Address - Zip Code:01701
Practice Address - Country:US
Practice Address - Phone:508-872-0041
Practice Address - Fax:508-879-7482
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA171461223G0001X
MA105741223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAX12213OtherBLUE CROSS BLUE SHIELD
MA380063OtherHARVARD PILGRIM HEALTHCAR