Provider Demographics
NPI:1245541200
Name:COUBROUGH, HEATHER ARLENE (DMD)
Entity type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:ARLENE
Last Name:COUBROUGH
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:274 NEWBURY ST
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02116-2403
Mailing Address - Country:US
Mailing Address - Phone:617-262-0106
Mailing Address - Fax:
Practice Address - Street 1:1037 BEACON STREET
Practice Address - Street 2:SUITE 2
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02446
Practice Address - Country:US
Practice Address - Phone:617-738-7210
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-24
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN1855459122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist