Provider Demographics
NPI:1962996025
Name:CENTRAL SQUARE DENTAL PC
Entity type:Organization
Organization Name:CENTRAL SQUARE DENTAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATION MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ASHLEE
Authorized Official - Middle Name:
Authorized Official - Last Name:BREWSTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-876-7900
Mailing Address - Street 1:14 PLEASANT ST
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02139-3212
Mailing Address - Country:US
Mailing Address - Phone:617-876-7900
Mailing Address - Fax:
Practice Address - Street 1:14 PLEASANT ST
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02139-3212
Practice Address - Country:US
Practice Address - Phone:617-876-7900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-21
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental