Provider Demographics
NPI:1124313622
Name:SOUTH END DENTAL ASSOCIATES
Entity type:Organization
Organization Name:SOUTH END DENTAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:STEPHEN
Authorized Official - Last Name:MORRISON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:617-357-4943
Mailing Address - Street 1:540 TREMONT ST
Mailing Address - Street 2:SUITE 7
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02116-6339
Mailing Address - Country:US
Mailing Address - Phone:617-357-4943
Mailing Address - Fax:617-412-4890
Practice Address - Street 1:540 TREMONT ST
Practice Address - Street 2:SUITE 7
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02116-6339
Practice Address - Country:US
Practice Address - Phone:617-357-4943
Practice Address - Fax:617-412-4890
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-13
Last Update Date:2011-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA205261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty