Provider Demographics
NPI:1619156171
Name:FARIS, CAROLINE B (DMD, DMSC)
Entity type:Individual
Prefix:DR
First Name:CAROLINE
Middle Name:B
Last Name:FARIS
Suffix:
Gender:F
Credentials:DMD, DMSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:255 MASSACHUSETTS AVE APT 815
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02115-3514
Mailing Address - Country:US
Mailing Address - Phone:617-435-0082
Mailing Address - Fax:
Practice Address - Street 1:1425 BEACON ST
Practice Address - Street 2:
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02446-4808
Practice Address - Country:US
Practice Address - Phone:617-731-3364
Practice Address - Fax:617-734-1553
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-31
Last Update Date:2007-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA217441223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics