Provider Demographics
NPI:1851466023
Name:WABAN DENTAL GROUP
Entity Type:Organization
Organization Name:WABAN DENTAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:S
Authorized Official - Last Name:HOWIE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:617-527-6061
Mailing Address - Street 1:1180 BEACON STREET
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02461-1103
Mailing Address - Country:US
Mailing Address - Phone:617-527-6061
Mailing Address - Fax:617-964-3919
Practice Address - Street 1:1180 BEACON STREET
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02461-1103
Practice Address - Country:US
Practice Address - Phone:617-527-6061
Practice Address - Fax:617-964-3919
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA141831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty