Provider Demographics
NPI:1952595696
Name:T.P.DEAHL D.D.S., P.C.
Entity Type:Organization
Organization Name:T.P.DEAHL D.D.S., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:DEAHL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:617-868-4046
Mailing Address - Street 1:2286 MASSACHSUETTS AVE
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02140
Mailing Address - Country:US
Mailing Address - Phone:617-868-4046
Mailing Address - Fax:617-868-5375
Practice Address - Street 1:2286 MASSACHUSETTS AVE
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02140-1812
Practice Address - Country:US
Practice Address - Phone:617-868-4046
Practice Address - Fax:617-868-5375
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-05
Last Update Date:2007-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA165741223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty