Provider Demographics
NPI:1720485535
Name:DB2 PRACTICE MANAGEMENT
Entity Type:Organization
Organization Name:DB2 PRACTICE MANAGEMENT
Other - Org Name:DENTAL BRIGHT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ENDODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ADELA
Authorized Official - Middle Name:
Authorized Official - Last Name:AGOLLI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:781-229-1111
Mailing Address - Street 1:11 CAMBRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01803
Mailing Address - Country:US
Mailing Address - Phone:781-229-1111
Mailing Address - Fax:781-229-1888
Practice Address - Street 1:11 CAMBRIDGE ST
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:MA
Practice Address - Zip Code:01803
Practice Address - Country:US
Practice Address - Phone:781-229-1111
Practice Address - Fax:781-229-1888
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DB PRACTICE MANAGEMENT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-11-21
Last Update Date:2014-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA22028261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental