Provider Demographics
NPI:1548915911
Name:BROOKLINE DENTAL STUDIO
Entity type:Organization
Organization Name:BROOKLINE DENTAL STUDIO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:IRINA
Authorized Official - Middle Name:
Authorized Official - Last Name:TOLMACH
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:617-566-5400
Mailing Address - Street 1:1247A BEACON ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02446-5202
Mailing Address - Country:US
Mailing Address - Phone:617-566-5400
Mailing Address - Fax:617-731-1535
Practice Address - Street 1:1247A BEACON ST
Practice Address - Street 2:
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02446-5202
Practice Address - Country:US
Practice Address - Phone:617-566-5400
Practice Address - Fax:617-731-1535
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-15
Last Update Date:2022-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty