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Organization
CDG BACK BAY LLC
Active
Organization
CDG BACK BAY LLC
Active
Other names
Commonwealth Dental Group
Organization subpart
No
Provider details
NPI number
Authorized official
KOSTANTINA TINA GIANNACOPOULOS (DENTAL DIRECTOR)
(617) 266-8770
Entity
Organization
Contact information
Practice address
400 COMMONWEALTH AVE 3RD FLOOR, BOSTON, MA 02215
(617) 266-8770
(617) 266-9530
Mailing address
400 COMMONWEALTH AVE 3RD FLOOR, BOSTON, MA 02215
(617) 266-8770
(617) 266-9530
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
09/18/2020
Last updated
10/27/2024
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