Coolidge Corner Dental
NPI #1861118721 in Brookline, Massachusetts
Provider Information
- NPI Number
- 1861118721
- Entity Type
- Organization
- Organization Name
- Coolidge Corner Dental
- Primary Specialty
- Dentist - General Practice
- Enumeration Date
- Oct 12, 2022
- Last Updated
- Oct 12, 2022
Practice Location
- Address
- 367 HARVARD ST
- City
- Brookline
- State
- Massachusetts
- ZIP Code
- 02446-2938
- Phone
- (617) 938-9161
Authorized Official
- Name
- SAMUEL USTAYEV, DMD
- Title
- PRESIDENT/ DENTIST
- Phone
- (617) 938-9161
Specialties & Taxonomy Codes
| Specialty |
|---|
| Dentist - General Practice — General Practice |
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