Provider Demographics
NPI:1376378505
Name:BOSTONIA DENTAL GROUP P.C
Entity type:Organization
Organization Name:BOSTONIA DENTAL GROUP P.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:OLIVER
Authorized Official - Middle Name:
Authorized Official - Last Name:CARVALHO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:617-505-3006
Mailing Address - Street 1:1842 BEACON ST STE 209
Mailing Address - Street 2:
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02445-1922
Mailing Address - Country:US
Mailing Address - Phone:617-505-3006
Mailing Address - Fax:
Practice Address - Street 1:1842 BEACON ST STE 209
Practice Address - Street 2:
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02445-1922
Practice Address - Country:US
Practice Address - Phone:617-505-3006
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-06
Last Update Date:2024-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty