Organization
RUSSELL L FORMAN, DMD, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RUSSELL LANG FORMAN D.M.D. (OWNER)
(617) 868-5500
Entity
Organization
Contact information
Practice address
875 MASSACHUSETTS AVE, SUITE 63, CAMBRIDGE, MA 02139-3067
(617) 868-5500
Mailing address
875 MASSACHUSETTS AVE, SUITE 63, CAMBRIDGE, MA 02139-3067
(617) 868-5500
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
DN18021
MA
Other
Enumeration date
09/22/2015
Last updated
09/22/2015
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