Organization
MASSACHUSETTS GENERAL PHYSICIANS ORGANIZATION
Active
Other names
MGH Dental Group
Organization subpart
No
Provider details
NPI number
Authorized official
DR. AGNES LAU DMD (DIRECTOR, MGH DENTAL GROUP)
(617) 726-1076
Entity
Organization
Contact information
Practice address
165 CAMBRIDGE ST, SUITE 401, BOSTON, MA 02114-2783
(617) 726-1076
(617) 724-6681
Mailing address
165 CAMBRIDGE ST, SUITE 401, BOSTON, MA 02114-2783
(617) 726-1076
(617) 724-6681
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
16139
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1364
DELTA DENTAL SPECIALIST
MA
01
—
774
DELTA DENTAL GROUP NUMBER
MA
05
—
9762779
—
MA
Enumeration date
01/16/2007
Last updated
08/22/2020
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