Provider Demographics
NPI:1972999233
Name:BOSTON DENTAL RESTORATIVE GROUP, LLC
Entity Type:Organization
Organization Name:BOSTON DENTAL RESTORATIVE GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:RENE
Authorized Official - Last Name:SCHROTT
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, MMSC
Authorized Official - Phone:617-227-4924
Mailing Address - Street 1:25 NEW CHARDON ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02114-4774
Mailing Address - Country:US
Mailing Address - Phone:617-227-4924
Mailing Address - Fax:617-227-1824
Practice Address - Street 1:25 NEW CHARDON ST
Practice Address - Street 2:SUITE 102
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-4774
Practice Address - Country:US
Practice Address - Phone:617-227-4924
Practice Address - Fax:617-227-1824
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-13
Last Update Date:2015-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty
No1223P0700XDental ProvidersDentistProsthodonticsGroup - Multi-Specialty