Organization
PRESIDENT AND FELLOWS OF HARVARD COLLEGE
Active
Other names
Harvard Dental Center FGP
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOHN DA SILVA DMD (MEDICAL DIRECTOR)
(617) 432-1440
Entity
Organization
Contact information
Practice address
188 LONGWOOD AVE, BOSTON, MA 02115-5819
(617) 432-1434
(617) 432-4258
Mailing address
188 LONGWOOD AVE, BOSTON, MA 02115-5819
(617) 432-1434
(617) 432-4258
Taxonomy
Speciality
Code
Description
License number
State
1223E0200X
Endodontics
12762
MA
1223G0001X
General Practice Dentistry
Primary
17724
MA
1223P0300X
Periodontics
16638
MA
1223P0700X
Prosthodontics
16484
MA
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
14710
MA
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
9239
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0200140
—
MA
Enumeration date
10/14/2006
Last updated
02/17/2016
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