Provider Demographics
NPI:1528722188
Name:LONGWOOD DENTAL PLLC
Entity type:Organization
Organization Name:LONGWOOD DENTAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:
Authorized Official - Last Name:SASSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-274-8528
Mailing Address - Street 1:12 WEBSTER ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02446-4938
Mailing Address - Country:US
Mailing Address - Phone:617-274-8528
Mailing Address - Fax:
Practice Address - Street 1:12 WEBSTER ST
Practice Address - Street 2:
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02446-4938
Practice Address - Country:US
Practice Address - Phone:617-274-8528
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-28
Last Update Date:2021-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty