Provider Demographics
NPI:1740866342
Name:BOSTON CENTER FOR ORAL HEALTH LLC
Entity type:Organization
Organization Name:BOSTON CENTER FOR ORAL HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:LUKE
Authorized Official - Middle Name:
Authorized Official - Last Name:AMNOTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-536-4620
Mailing Address - Street 1:400 COMMONWEALTH AVE STE 104B
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02215-2813
Mailing Address - Country:US
Mailing Address - Phone:617-536-4620
Mailing Address - Fax:617-536-3872
Practice Address - Street 1:400 COMMONWEALTH AVE STE 104B
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215-2813
Practice Address - Country:US
Practice Address - Phone:617-536-4620
Practice Address - Fax:617-536-3872
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-23
Last Update Date:2021-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173F00000XOther Service ProvidersSleep Specialist, PhDGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA16477OtherDENTAL LICENSE NUMBER