Provider Demographics
NPI:1629655121
Name:TOMBARI, MADISON C
Entity Type:Individual
Prefix:
First Name:MADISON
Middle Name:C
Last Name:TOMBARI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 ALBANY ST UNIT 204
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118-2790
Mailing Address - Country:US
Mailing Address - Phone:781-974-4151
Mailing Address - Fax:
Practice Address - Street 1:HARBOR HEALTH
Practice Address - Street 2:250 MT VERNON ST
Practice Address - City:DORCHESTER
Practice Address - State:MA
Practice Address - Zip Code:02125
Practice Address - Country:US
Practice Address - Phone:617-269-0312
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-29
Last Update Date:2021-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADL14851122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist