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Individual

EDWARD T LAHEY III

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD, DMD

Contact information

Practice address
1 KNEELAND ST FL 5, BOSTON, MA 02111-1529
(617) 636-6515
(617) 636-6809
Mailing address
1 KNEELAND ST FL 5, BOSTON, MA 02111-1529
(617) 636-6515
(617) 636-6809

Taxonomy

Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
DN21157
MA
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
Primary
230038
MA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
X09477
BLUE SHIELD
MA
Enumeration date
07/30/2006
Last updated
08/04/2023
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