Provider Demographics
NPI:1821862871
Name:BEDFORD DENTAL LLC
Entity Type:Organization
Organization Name:BEDFORD DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LEONID
Authorized Official - Middle Name:
Authorized Official - Last Name:KHARIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-953-9358
Mailing Address - Street 1:104 PHILIP FARM RD
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:MA
Mailing Address - Zip Code:01742-2712
Mailing Address - Country:US
Mailing Address - Phone:617-953-9358
Mailing Address - Fax:
Practice Address - Street 1:41 NORTH RD STE 107
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:MA
Practice Address - Zip Code:01730-1037
Practice Address - Country:US
Practice Address - Phone:781-275-7153
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-09
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty