Provider Demographics
NPI:1922114420
Name:CHESTNUT HILL DENTAL ASSOC
Entity Type:Organization
Organization Name:CHESTNUT HILL DENTAL ASSOC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:PEYMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BEIGI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:617-566-0308
Mailing Address - Street 1:2001 BEACON ST
Mailing Address - Street 2:STE 300
Mailing Address - City:BRIGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02135-7786
Mailing Address - Country:US
Mailing Address - Phone:617-566-0308
Mailing Address - Fax:617-566-8073
Practice Address - Street 1:2001 BEACON ST
Practice Address - Street 2:STE 300
Practice Address - City:BRIGHTON
Practice Address - State:MA
Practice Address - Zip Code:02135-7786
Practice Address - Country:US
Practice Address - Phone:617-566-0308
Practice Address - Fax:617-566-8073
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-21
Last Update Date:2008-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA190491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty