Individual
DR. RUSSELL LANG FORMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.M.D.
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
1223G0001X
General Practice Dentistry
Primary
18021
MA
Other
Enumeration date
01/14/2007
Last updated
07/08/2007
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