Provider Demographics
NPI:1700461548
Name:AHD-CANTON, LLC
Entity Type:Organization
Organization Name:AHD-CANTON, LLC
Other - Org Name:BOSTON STREET DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:HURLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:920-421-2654
Mailing Address - Street 1:246 S CHESTER ST
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21231-2625
Mailing Address - Country:US
Mailing Address - Phone:920-421-2654
Mailing Address - Fax:
Practice Address - Street 1:1501 S CLINTON ST STE 335
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21224-5753
Practice Address - Country:US
Practice Address - Phone:410-276-4455
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-12
Last Update Date:2021-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental