Organization
MASSACHUSETTS GENERAL HOSPITAL ORAL & MAXILLOFACIAL SURGERY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LEONARD BRUCE KABAN M.D. (CHIEF)
(617) 726-2740
Entity
Organization
Contact information
Practice address
55 FRUIT ST, WANG AMBULATORY BUILDING SUITE 230, BOSTON, MA 02114-2621
(617) 726-8222
Mailing address
55 FRUIT ST, WANG AMBULATORY BUILDING SUITE 230, BOSTON, MA 02114-2621
Taxonomy
Speciality
Code
Description
License number
State
261QS0112X
Oral and Maxillofacial Surgery Clinic/Center
—
—
282N00000X
General Acute Care Hospital
Primary
P-36801
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110008955/B
—
MA
Enumeration date
08/08/2011
Last updated
08/08/2011
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