Provider Demographics
NPI:1720381064
Name:TRUSTEES OF TUFTS UNIVERSITY
Entity Type:Organization
Organization Name:TRUSTEES OF TUFTS UNIVERSITY
Other - Org Name:TUFTS DENTAL FACILITY GPR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF CLINICAL OPERATIONS
Authorized Official - Prefix:DR
Authorized Official - First Name:DARREN
Authorized Official - Middle Name:J
Authorized Official - Last Name:DRAG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-899-6020
Mailing Address - Street 1:1 KNEELAND STREET
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02111
Mailing Address - Country:US
Mailing Address - Phone:617-636-6669
Mailing Address - Fax:
Practice Address - Street 1:1 KNEELAND STREET
Practice Address - Street 2:3RD FLOOR
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02111
Practice Address - Country:US
Practice Address - Phone:617-636-6669
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-08
Last Update Date:2010-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA20040261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental