Provider Demographics
NPI:1952731549
Name:BOSTON UNIVERSITY HENRY M. GOLDMAN SCHOOL OF DENTAL MEDICINE
Entity type:Organization
Organization Name:BOSTON UNIVERSITY HENRY M. GOLDMAN SCHOOL OF DENTAL MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:ANAMARIA
Authorized Official - Middle Name:
Authorized Official - Last Name:DE LOS SANTOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-638-4683
Mailing Address - Street 1:100 E NEWTON ST # G-200
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118-2308
Mailing Address - Country:US
Mailing Address - Phone:617-638-4683
Mailing Address - Fax:
Practice Address - Street 1:100 E NEWTON ST # G-200
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02118-2308
Practice Address - Country:US
Practice Address - Phone:617-638-4683
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BOSTON UNIVERSITY HENRY M. GOLDMAN SCHOOL OF DENTAL MEDICINE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-11-18
Last Update Date:2013-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty