Back Bay Dental Group LLC

NPI #1063758639 in Boston, Massachusetts

Provider Information

NPI Number: 1063758639
Entity Type: Organization
Organization Name: Back Bay Dental Group LLC
Primary Specialty: Dentist
Enumeration Date: Dec 29, 2012
Last Updated: Jan 3, 2013

Practice Location

Address: 21 BAY STATE RD
City: Boston
State: Massachusetts
ZIP Code: 02215-2101
Phone: (617) 247-9966

Authorized Official

Name: DR. RICHARD MILLER, DMD
Title: PRESIDENT
Phone: (617) 921-6292

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist	122300000X	Primary

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