Organization
ALL DENTAL OF REVERE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ANDREY MAZO (PRESIDENT)
(617) 285-6414
Entity
Organization
Contact information
Practice address
370 BROADWAY, REVERE, MA 02151-5016
(617) 547-0700
Mailing address
370 BROADWAY, REVERE, MA 02151-5016
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
18643
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0277975
—
MA
Enumeration date
10/16/2015
Last updated
10/16/2015
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