Provider Demographics
NPI:1144276601
Name:NEWTON DENTAL ASSOCIATES
Entity type:Organization
Organization Name:NEWTON DENTAL ASSOCIATES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:ANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:BERIK
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:617-965-0060
Mailing Address - Street 1:93 UNION ST
Mailing Address - Street 2:SUITE #402
Mailing Address - City:NEWTON CENTER
Mailing Address - State:MA
Mailing Address - Zip Code:02459-2244
Mailing Address - Country:US
Mailing Address - Phone:617-965-0060
Mailing Address - Fax:
Practice Address - Street 1:93 UNION ST
Practice Address - Street 2:SUITE #402
Practice Address - City:NEWTON CENTER
Practice Address - State:MA
Practice Address - Zip Code:02459-2244
Practice Address - Country:US
Practice Address - Phone:617-965-0060
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA0184981223G0001X
MA187851223E0200X
MA185051223G0001X
MA186101223P0106X
MA126551223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Not Answered1223E0200XDental ProvidersDentistEndodonticsGroup - Multi-Specialty
Not Answered1223P0106XDental ProvidersDentistOral and Maxillofacial PathologyGroup - Multi-Specialty
Not Answered1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty