Organization
COMMONWEALTH OF MASSACHUSETTS
Active
Parent organization
COMMONWEALTH OF MASSACHUSETTS
Other names
DDS Greater Boston Area Office, GBA WEST BOSTON-BROOKLINE AREA
Organization subpart
Yes
Provider details
NPI number
Legal business name
COMMONWEALTH OF MASSACHUSETTS
Authorized official
DYLAN LATTIMORE (DEPUTY COMMISSIONER FOR ADMINISTRAT)
(857) 408-0675
Entity
Organization
Contact information
Practice address
65 SPRAGUE ST, HYDE PARK, MA 02136
(617) 363-2900
Mailing address
40 BROAD STREET, 4TH FLOOR, BOSTON, MA 02109
(617) 727-5608
(617) 624-7577
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110000087I
—
MA
05
—
1813005
—
MA
Enumeration date
03/08/2007
Last updated
03/19/2026
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