# GREATER BOSTON ORAL SURGERY AND DENTAL IMPLANT CENTER PLLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Greater Boston Oral Surgery and Dental Implant Center
- **Organization subpart:** No

## Provider details

- **NPI number:** 1225915770
- **Authorized official:** CHAD HENDRICKS (CREDENTIALING)
- **Authorized official phone:** (612) 859-0444

## Contact information

- **Practice address:** 101 MAIN ST STE 201, MEDFORD, MA 02155-4530
- **Practice address phone:** (617) 875-7827
- **Mailing address:** 101 MAIN ST STE 201, MEDFORD, MA 02155-4530
- **Mailing address phone:** (617) 875-7827

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | — | NULL | Yes |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | — | — | Yes |

## Other

- **Enumeration date:** 08/18/2025
- **Last updated:** 08/18/2025