Provider Demographics
NPI:1568997930
Name:ADVANCED DENTAL SOLUTIONS LLC
Entity Type:Organization
Organization Name:ADVANCED DENTAL SOLUTIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DAREL
Authorized Official - Middle Name:D
Authorized Official - Last Name:MOSS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:617-818-8695
Mailing Address - Street 1:1682 BEACON ST
Mailing Address - Street 2:UNIT 1
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02445-2120
Mailing Address - Country:US
Mailing Address - Phone:617-818-8695
Mailing Address - Fax:
Practice Address - Street 1:1682 BEACON ST
Practice Address - Street 2:UNIT 1
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02445-2120
Practice Address - Country:US
Practice Address - Phone:617-818-8695
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-24
Last Update Date:2017-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA13492261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental