Provider Demographics
NPI:1851871081
Name:BOSTON PREMIER DENTISTRY, PC
Entity Type:Organization
Organization Name:BOSTON PREMIER DENTISTRY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KOUROSH
Authorized Official - Middle Name:
Authorized Official - Last Name:ASHA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:781-346-4298
Mailing Address - Street 1:73 LITCHFIELD ST
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02135-1215
Mailing Address - Country:US
Mailing Address - Phone:781-346-4298
Mailing Address - Fax:
Practice Address - Street 1:10 TREMONT ST STE 402
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02108-2062
Practice Address - Country:US
Practice Address - Phone:781-346-4298
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-16
Last Update Date:2018-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN1857266261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental