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Organization

SOMERVILLE DENTISTRY AND BRACES, P.C.

Active
Organization subpart
No

Provider details

NPI number
Authorized official
JOANNE TAVANO (CFO)
(978) 580-1524
Entity
Organization

Contact information

Practice address
5 MIDDLESEX AVE STE 305, SOMERVILLE, MA 02145-1110
(508) 872-3072
Mailing address
5 MOUNT ROYAL AVE STE 300, MARLBOROUGH, MA 01752-1900
(508) 723-0725
(508) 872-0781

Taxonomy

Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DN20209
MA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
DN20209
STATE LICENSE
MA
Enumeration date
09/05/2018
Last updated
09/05/2018
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