1679669717 NPI number — GERALD G. UDLER, D.M.D., P.C.

Table of content: JILL STAFFENBERG MS, CCC-SLP (NPI 1073003133)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679669717 NPI number — GERALD G. UDLER, D.M.D., P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GERALD G. UDLER, D.M.D., P.C.
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:
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:
1679669717
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:
1244 BOYLSTON ST
Provider Second Line Business Mailing Address:
SUITE 205
Provider Business Mailing Address City Name:
CHESTNUT HILL
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02467-2116
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
617-735-0800
Provider Business Mailing Address Fax Number:
617-735-0801

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1244 BOYLSTON ST
Provider Second Line Business Practice Location Address:
SUITE 205
Provider Business Practice Location Address City Name:
CHESTNUT HILL
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02467-2116
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
617-735-0800
Provider Business Practice Location Address Fax Number:
617-735-0801
Provider Enumeration Date:
10/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
UDLER
Authorized Official First Name:
GERALD
Authorized Official Middle Name:
G
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
617-735-0800

Provider Taxonomy Codes

  • Taxonomy code: 1223P0221X , with the licence number:  11348 , 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: 0256951 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: X10928 . This is a "BLUE CROSS & BLUE SHIELD" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com