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Organization
RUSTAM K. DE VITRE, DMD
Active
Organization
RUSTAM K. DE VITRE, DMD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RUSTAM K DE VITRE D.M.D. (OWNER)
(617) 236-5969
Entity
Organization
Contact information
Practice address
392 COMMONWEALTH AVE, BOSTON, MA 02215
(617) 236-5969
(617) 424-6298
Mailing address
392 COMMONWEALTH AVE, BOSTON, MA 02215
(617) 236-5969
(617) 424-6298
Taxonomy
Speciality
Code
Description
License number
State
1223E0200X
Endodontics
20322
MA
1223P0300X
Periodontics
18265
MA
1223P0700X
Prosthodontics
Primary
13701
MA
Other
Enumeration date
04/17/2007
Last updated
08/27/2008
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