Provider Demographics
NPI:1700409620
Name:CITIDENTA TREMONT PLLC
Entity Type:Organization
Organization Name:CITIDENTA TREMONT PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LINA
Authorized Official - Middle Name:
Authorized Official - Last Name:BADAWI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-817-3312
Mailing Address - Street 1:63 COURT ST
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02108-2109
Mailing Address - Country:US
Mailing Address - Phone:617-723-6300
Mailing Address - Fax:
Practice Address - Street 1:32 TREMONT ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02108-3201
Practice Address - Country:US
Practice Address - Phone:617-982-7758
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-27
Last Update Date:2020-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No1223E0200XDental ProvidersDentistEndodonticsGroup - Multi-Specialty
No1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty