1114124765 NPI number — FORSYTH HYGIENE PROGRAM

Table of content: (NPI 1114124765)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114124765 NPI number — FORSYTH HYGIENE PROGRAM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FORSYTH HYGIENE PROGRAM
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:
Provider Other Organization Name Type Code:
6
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:
1114124765
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/12/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
179 LONGWOOD AVE
Provider Second Line Business Mailing Address:
FORSTYH SCHOOL OF DENTAL HYGIENE
Provider Business Mailing Address City Name:
BOSTON
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02115-5804
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
617-278-2700
Provider Business Mailing Address Fax Number:
617-732-2912

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
179 LONGWOOD AVE
Provider Second Line Business Practice Location Address:
FORSTYH SCHOOL OF DENTAL HYGIENE
Provider Business Practice Location Address City Name:
BOSTON
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02115-5804
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
617-278-2700
Provider Business Practice Location Address Fax Number:
617-732-2912
Provider Enumeration Date:
06/28/2007

Additional Information

Authorized Official

Authorized Official Last Name:
FOLEY
Authorized Official First Name:
MARY
Authorized Official Middle Name:
Authorized Official Title or Position:
DEAN OF FORSYTH SCHOOL OF DENTAL HY
Authorized Official Telephone Number:
617-735-1049

Provider Taxonomy Codes

  • Taxonomy code: 261QD0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 210013 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".




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