Provider Demographics
NPI:1649301805
Name:JEFFREY C. SACKS DMD MS PC
Entity type:Organization
Organization Name:JEFFREY C. SACKS DMD MS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:SACKS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD MS
Authorized Official - Phone:617-731-8888
Mailing Address - Street 1:25 BOYLSTON ST
Mailing Address - Street 2:SUITE LL02
Mailing Address - City:CHESTNUT HILL
Mailing Address - State:MA
Mailing Address - Zip Code:02467-1715
Mailing Address - Country:US
Mailing Address - Phone:617-731-8888
Mailing Address - Fax:
Practice Address - Street 1:25 BOYLSTON ST
Practice Address - Street 2:SUITE LL02
Practice Address - City:CHESTNUT HILL
Practice Address - State:MA
Practice Address - Zip Code:02467-1715
Practice Address - Country:US
Practice Address - Phone:617-731-8888
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA170891223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD16612OtherHARVARD PILGRIM
MA70235804OtherTUFTS
MAX10492OtherBLUE CROSS BLUE SHIELD
MAX30010Medicare ID - Type Unspecified