Provider Demographics
NPI:1760725287
Name:PRESIDENT & FELLOWS OF HARVARD COLLEGE
Entity Type:Organization
Organization Name:PRESIDENT & FELLOWS OF HARVARD COLLEGE
Other - Org Name:HUHS DENTAL SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF OF SERVICE
Authorized Official - Prefix:DR
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:MICHELE
Authorized Official - Last Name:MARDIS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:617-495-2063
Mailing Address - Street 1:75 MOUNT AUBURN ST
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02138-4960
Mailing Address - Country:US
Mailing Address - Phone:617-495-2063
Mailing Address - Fax:617-496-0562
Practice Address - Street 1:75 MOUNT AUBURN ST
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02138-4960
Practice Address - Country:US
Practice Address - Phone:617-495-2063
Practice Address - Fax:617-496-0562
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PRESIDENT & FELLOWS OF HARVARD COLLEGE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-04-03
Last Update Date:2013-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4RA2261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental