Provider Demographics
NPI:1619495090
Name:BRITO FAMILY DENTAL
Entity Type:Organization
Organization Name:BRITO FAMILY DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:BRITO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:978-590-4591
Mailing Address - Street 1:280A SHAWMUT AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118-2196
Mailing Address - Country:US
Mailing Address - Phone:978-590-4591
Mailing Address - Fax:
Practice Address - Street 1:272 W BROADWAY
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02127-1913
Practice Address - Country:US
Practice Address - Phone:978-590-4591
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-06
Last Update Date:2017-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN1856499261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental