Provider Demographics
NPI:1972602092
Name:NEVINS, MARC L (DMD MMSC,PC)
Entity Type:Individual
Prefix:DR
First Name:MARC
Middle Name:L
Last Name:NEVINS
Suffix:
Gender:M
Credentials:DMD MMSC,PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 CAMBRIDGE ST
Mailing Address - Street 2:SUITE 310
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02114-2743
Mailing Address - Country:US
Mailing Address - Phone:617-720-0285
Mailing Address - Fax:617-720-0836
Practice Address - Street 1:175 CAMBRIDGE ST
Practice Address - Street 2:SUITE 310
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2743
Practice Address - Country:US
Practice Address - Phone:617-720-0285
Practice Address - Fax:617-720-0836
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA185101223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics