Organization
MAVERICK FAMILY DENTAL PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JULIA FAIGEL DMD (PRESIDENT)
(617) 567-3800
Entity
Organization
Contact information
Practice address
45 MAVERICK SQ, EAST BOSTON, MA 02128-2312
(617) 567-3800
(617) 567-3802
Mailing address
45 MAVERICK SQ, EAST BOSTON, MA 02128-2312
(617) 567-3800
(617) 567-3802
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
20485
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0203980
—
MA
Enumeration date
01/13/2007
Last updated
04/03/2008
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