Provider Demographics
NPI:1851015564
Name:WATERTOWN DENTAL ASSOCIATES PLLC
Entity Type:Organization
Organization Name:WATERTOWN DENTAL ASSOCIATES PLLC
Other - Org Name:DENTISTRY BY DESIGN BOSTON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:THEODORE
Authorized Official - Last Name:PAPAPETROS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:978-886-2678
Mailing Address - Street 1:1 INTERNATIONAL PL FL 7
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02110-2602
Mailing Address - Country:US
Mailing Address - Phone:617-330-8887
Mailing Address - Fax:
Practice Address - Street 1:1 INTERNATIONAL PL FL 7
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02110-2602
Practice Address - Country:US
Practice Address - Phone:617-330-8887
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-27
Last Update Date:2022-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental