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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