Organization · Type 2 NPI

CDG Back Bay LLC

Dental Clinic/Center · Boston, MA

NPI number 1114533866 Active

Practice location

400 Commonwealth Ave 3rd Floor
Boston, MA 02215

Fax (617) 266-9530

Specialties and licenses

Taxonomy	Code	License
Dental Clinic/Center Primary	261QD0000X	None listed

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NPI record

NPI: 1114533866
Entity type: Organization (Type 2)
Issued: Sep 18, 2020
Last updated: Oct 27, 2024
Status: Active

Other names

<unavail>
Commonwealth Dental Group · doing business as
Commonwealth Dental Group · doing business as

Authorized official

Kostantina Tina Giannacopoulos
Dental Director
(617) 266-8770

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About NPI 1114533866

CDG Back Bay LLC's National Provider Identifier is 1114533866, issued on Sep 18, 2020. The primary taxonomy on file is Dental Clinic/Center (261QD0000X), and the practice location is in Boston, MA. The record was last updated on Oct 27, 2024.