1295959849 NPI number — TRUSTEES OF TUFTS UNIVERSITY

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295959849 NPI number — TRUSTEES OF TUFTS UNIVERSITY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TRUSTEES OF TUFTS UNIVERSITY
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
TUFTS DENTAL FACILITY WRENTHAM
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1295959849
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 144
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WRENTHAM
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02093-0144
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-384-8987
Provider Business Mailing Address Fax Number:
508-384-6594

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
200 TRAPELO RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WALTHAM
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02452-6332
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-384-8987
Provider Business Practice Location Address Fax Number:
508-384-6594
Provider Enumeration Date:
04/13/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MORGAN
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
PATRICK
Authorized Official Title or Position:
ADMINISTRATIVE DIRECTOR
Authorized Official Telephone Number:
781-899-6020

Provider Taxonomy Codes

  • Taxonomy code: 261QD0000X , with the licence number:  20040 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0272191 . This is a "MASSHEALTH PROVIDER NUMBE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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