Provider Demographics
NPI:1104999028
Name:HIRSHBERG DENTAL ASSOC OF BOSTON PC
Entity type:Organization
Organization Name:HIRSHBERG DENTAL ASSOC OF BOSTON PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:HIRSHBERG
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:617-542-8808
Mailing Address - Street 1:12 POST OFFICE SQUARE
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02109
Mailing Address - Country:US
Mailing Address - Phone:617-542-8808
Mailing Address - Fax:617-451-1912
Practice Address - Street 1:12 POST OFFICE SQUARE
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02109
Practice Address - Country:US
Practice Address - Phone:617-542-8808
Practice Address - Fax:617-451-1912
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA128921223G0001X
MA191691223G0001X
MA181481223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Not Answered1223P0700XDental ProvidersDentistProsthodonticsGroup - Multi-Specialty