Provider Demographics
NPI:1124240783
Name:NORTHEAST DENTAL ASSOCIATES
Entity type:Organization
Organization Name:NORTHEAST DENTAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HERBERT
Authorized Official - Middle Name:S
Authorized Official - Last Name:YOLIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:617-730-8989
Mailing Address - Street 1:1842 BEACON STREET
Mailing Address - Street 2:SUITE 302
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02445-1930
Mailing Address - Country:US
Mailing Address - Phone:617-730-8989
Mailing Address - Fax:617-730-8913
Practice Address - Street 1:1842 BEACON STREET
Practice Address - Street 2:SUITE 302
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02445-1930
Practice Address - Country:US
Practice Address - Phone:617-730-8989
Practice Address - Fax:617-730-8913
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA97721223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY51489OtherBCBS OF MA