Individual
ETHAN ROBERT TENCATI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
55 FRUIT ST, BOSTON, MA 02114-2696
(617) 726-2000
Mailing address
15 RIDGEWAY RD, NORTH READING, MA 01864-1704
(714) 787-9665
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
DL14789
MA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
05/29/2020
Last updated
06/28/2021
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