Organization
MATTAPAN SQUARE FAMILY DENTAL PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ALEX FAIGEL (MANAGER)
(617) 823-2111
Entity
Organization
Contact information
Practice address
1634 BLUE HILL AVE, MATTAPAN, MA 02126-2121
(617) 298-2000
(617) 298-2002
Mailing address
1634 BLUE HILL AVE, MATTAPAN, MA 02126-2121
(617) 298-2000
(617) 298-2002
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
20485
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0203980
—
MA
Enumeration date
03/28/2008
Last updated
03/28/2008
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