Provider Demographics
NPI:1639183841
Name:LECHTENBERG, EDWARD L (DMD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:L
Last Name:LECHTENBERG
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2353 MASSACHUSETTS AVE
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02140-1252
Mailing Address - Country:US
Mailing Address - Phone:617-492-8700
Mailing Address - Fax:617-492-0698
Practice Address - Street 1:2353 MASSACHUSETTS AVE
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02140-1252
Practice Address - Country:US
Practice Address - Phone:617-492-8700
Practice Address - Fax:617-492-0698
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA108231223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAX03883Medicare ID - Type Unspecified
MA27050Medicare UPIN