Provider Demographics
NPI:1740206259
Name:BIRNBAUM, NATHAN SIMCHA (DDS CAGS)
Entity Type:Individual
Prefix:DR
First Name:NATHAN
Middle Name:SIMCHA
Last Name:BIRNBAUM
Suffix:
Gender:M
Credentials:DDS CAGS
Other - Prefix:
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Mailing Address - Street 1:1 WASHINGTON ST
Mailing Address - Street 2:SUITE 306
Mailing Address - City:WELLESLEY
Mailing Address - State:MA
Mailing Address - Zip Code:02481-1706
Mailing Address - Country:US
Mailing Address - Phone:781-431-9999
Mailing Address - Fax:781-431-9195
Practice Address - Street 1:1 WASHINGTON ST
Practice Address - Street 2:SUITE 306
Practice Address - City:WELLESLEY
Practice Address - State:MA
Practice Address - Zip Code:02481-1706
Practice Address - Country:US
Practice Address - Phone:781-431-9999
Practice Address - Fax:781-431-9195
Is Sole Proprietor?:No
Enumeration Date:2006-07-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA119291223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics