Provider Demographics
NPI:1679669717
Name:GERALD G. UDLER, D.M.D., P.C.
Entity Type:Organization
Organization Name:GERALD G. UDLER, D.M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:G
Authorized Official - Last Name:UDLER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:617-735-0800
Mailing Address - Street 1:1244 BOYLSTON ST
Mailing Address - Street 2:SUITE 205
Mailing Address - City:CHESTNUT HILL
Mailing Address - State:MA
Mailing Address - Zip Code:02467-2116
Mailing Address - Country:US
Mailing Address - Phone:617-735-0800
Mailing Address - Fax:617-735-0801
Practice Address - Street 1:1244 BOYLSTON ST
Practice Address - Street 2:SUITE 205
Practice Address - City:CHESTNUT HILL
Practice Address - State:MA
Practice Address - Zip Code:02467-2116
Practice Address - Country:US
Practice Address - Phone:617-735-0800
Practice Address - Fax:617-735-0801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA113481223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0256951Medicaid
MAX10928OtherBLUE CROSS & BLUE SHIELD