Organization
COOLIDGE CORNER DENTAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SAMUEL USTAYEV DMD (PRESIDENT/ DENTIST)
(617) 938-9161
Entity
Organization
Contact information
Practice address
367 HARVARD ST, BROOKLINE, MA 02446-2938
(617) 938-9161
Mailing address
32 TRAVELER ST UNIT 212, BOSTON, MA 02118-2843
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
10/12/2022
Last updated
10/12/2022
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