Provider Demographics
NPI:1114124765
Name:FORSYTH HYGIENE PROGRAM
Entity type:Organization
Organization Name:FORSYTH HYGIENE PROGRAM
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DEAN OF FORSYTH SCHOOL OF DENTAL HY
Authorized Official - Prefix:MS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:FOLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-735-1049
Mailing Address - Street 1:179 LONGWOOD AVE
Mailing Address - Street 2:FORSTYH SCHOOL OF DENTAL HYGIENE
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02115-5804
Mailing Address - Country:US
Mailing Address - Phone:617-278-2700
Mailing Address - Fax:617-732-2912
Practice Address - Street 1:179 LONGWOOD AVE
Practice Address - Street 2:FORSTYH SCHOOL OF DENTAL HYGIENE
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115-5804
Practice Address - Country:US
Practice Address - Phone:617-278-2700
Practice Address - Fax:617-732-2912
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MASSACHUETTS COLLEGE OR PHARMACY/HEALTH SCIENCES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-06-28
Last Update Date:2008-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA210013Medicaid