Provider Demographics
NPI:1568862712
Name:AMG FAMILY DENTAL
Entity Type:Organization
Organization Name:AMG FAMILY DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:GOHAR
Authorized Official - Middle Name:
Authorized Official - Last Name:MKRTCHYAN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:617-484-0064
Mailing Address - Street 1:71 CONCORD AVE
Mailing Address - Street 2:
Mailing Address - City:BELMONT
Mailing Address - State:MA
Mailing Address - Zip Code:02478-4028
Mailing Address - Country:US
Mailing Address - Phone:617-484-0064
Mailing Address - Fax:617-484-0650
Practice Address - Street 1:71 CONCORD AVE
Practice Address - Street 2:
Practice Address - City:BELMONT
Practice Address - State:MA
Practice Address - Zip Code:02478-4028
Practice Address - Country:US
Practice Address - Phone:617-484-0064
Practice Address - Fax:617-484-0650
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-25
Last Update Date:2014-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN21526122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty