Provider Demographics
NPI:1952447831
Name:DULONG KRONSTEIN MC MANAMA FISH PC
Entity Type:Organization
Organization Name:DULONG KRONSTEIN MC MANAMA FISH PC
Other - Org Name:RESTORATIVE DENTAL GROUP OF CAMBRIDGE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:FISH
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:617-492-6070
Mailing Address - Street 1:181 CONCORD AVE
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02138-2317
Mailing Address - Country:US
Mailing Address - Phone:617-492-6070
Mailing Address - Fax:617-576-3848
Practice Address - Street 1:181 CONCORD AVE
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02138-2317
Practice Address - Country:US
Practice Address - Phone:617-492-6070
Practice Address - Fax:617-576-3848
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Not Answered1223P0700XDental ProvidersDentistProsthodonticsGroup - Multi-Specialty