Organization
CONVIVIAL DENTAL PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ATHANASIOS ZAVRAS D.D.S, M.S, D.M.SC (PRESIDENT)
(617) 818-0573
Entity
Organization
Contact information
Practice address
1244 BOYLSTON ST STE 205, CHESTNUT HILL, MA 02467-2115
(617) 818-0573
Mailing address
64 PINE ST, DOVER, MA 02030-2426
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
DN1855922
MA
261QM1300X
Multi-Specialty Clinic/Center
DN1855922
MA
Other
Enumeration date
08/11/2013
Last updated
08/11/2013
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