Provider Demographics
NPI:1639356033
Name:ALLSTON FAMILY DENTAL
Entity Type:Organization
Organization Name:ALLSTON FAMILY DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:CASEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-415-7460
Mailing Address - Street 1:127 HARVARD AVE
Mailing Address - Street 2:
Mailing Address - City:ALLSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02134-2702
Mailing Address - Country:US
Mailing Address - Phone:617-789-4200
Mailing Address - Fax:617-789-4202
Practice Address - Street 1:127 HARVARD AVE
Practice Address - Street 2:
Practice Address - City:ALLSTON
Practice Address - State:MA
Practice Address - Zip Code:02134-2702
Practice Address - Country:US
Practice Address - Phone:617-789-4200
Practice Address - Fax:617-789-4202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-28
Last Update Date:2008-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty