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Organization

SOUTH BOSTON COMMUNITY HEALTH CENTER

Active
Organization subpart
No

Provider details

NPI number
Authorized official
AKINOLA OGUNGBADERO (CFO)
(617) 269-7500
Entity
Organization

Contact information

Practice address
409 W BROADWAY, SOUTH BOSTON, MA 02127-2245
(617) 269-7500
(617) 464-7581
Mailing address
409 W BROADWAY, SOUTH BOSTON, MA 02127-2245
(617) 269-7500
(617) 464-7581

Taxonomy

Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
MA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
X10787
BLUE CROSS DENTAL
MA
Enumeration date
12/21/2007
Last updated
12/21/2007
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