Provider Demographics
NPI:1619583168
Name:NEWTON WELLESLEY DENTAL GROUP LLC
Entity Type:Organization
Organization Name:NEWTON WELLESLEY DENTAL GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDITING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:LORRAINE
Authorized Official - Middle Name:E
Authorized Official - Last Name:MATHEUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-567-0457
Mailing Address - Street 1:447 CENTRE STREET
Mailing Address - Street 2:SAME
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02458
Mailing Address - Country:US
Mailing Address - Phone:617-244-4133
Mailing Address - Fax:
Practice Address - Street 1:447 CENTRE STREET
Practice Address - Street 2:SAME
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02458
Practice Address - Country:US
Practice Address - Phone:617-244-4133
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-21
Last Update Date:2020-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental