Organization
MOUNT IDA COLLEGE
Active
Other names
Mount Ida College Dental Center
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GARY MELVIN BECKETT D.D.S. (SUPERVISING DENTIST)
(617) 928-7360
Entity
Organization
Contact information
Practice address
777 DEDHAM ST, NEWTON, MA 02459-3323
(617) 928-7360
(617) 928-7030
Mailing address
777 DEDHAM ST, NEWTON, MA 02459-3323
(617) 928-7360
(617) 928-7030
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
15111
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0297658
—
MA
Enumeration date
04/06/2007
Last updated
08/22/2020
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