Provider Demographics
NPI:1184282832
Name:WEST BOYLSTON DENTAL PC
Entity type:Organization
Organization Name:WEST BOYLSTON DENTAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FELIPE
Authorized Official - Middle Name:
Authorized Official - Last Name:AVERY -MIRANDA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:617-669-9664
Mailing Address - Street 1:71 CENTRAL ST
Mailing Address - Street 2:
Mailing Address - City:WEST BOYLSTON
Mailing Address - State:MA
Mailing Address - Zip Code:01583-1689
Mailing Address - Country:US
Mailing Address - Phone:508-835-3146
Mailing Address - Fax:
Practice Address - Street 1:71 CENTRAL ST
Practice Address - Street 2:
Practice Address - City:WEST BOYLSTON
Practice Address - State:MA
Practice Address - Zip Code:01583-1689
Practice Address - Country:US
Practice Address - Phone:508-835-3146
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-29
Last Update Date:2019-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty