Provider Demographics
NPI:1861530743
Name:WELLESLEY ENDODONTICS, INC.
Entity type:Organization
Organization Name:WELLESLEY ENDODONTICS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ENDODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:C. ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLDBERG
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:781-237-1801
Mailing Address - Street 1:40 GROVE ST
Mailing Address - Street 2:SUITE 420
Mailing Address - City:WELLESLEY
Mailing Address - State:MA
Mailing Address - Zip Code:02482-7702
Mailing Address - Country:US
Mailing Address - Phone:781-237-1801
Mailing Address - Fax:781-237-8803
Practice Address - Street 1:40 GROVE ST
Practice Address - Street 2:SUITE 420
Practice Address - City:WELLESLEY
Practice Address - State:MA
Practice Address - Zip Code:02482-7702
Practice Address - Country:US
Practice Address - Phone:781-237-1801
Practice Address - Fax:781-237-8803
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA125701223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty