Organization · Type 2 NPI

Form Dentistry PLLC

General Practice Dentistry · Waltham, MA

NPI number 1841194412 Active

Practice location

66 South St
Waltham, MA 02453-3537

Call (781) 899-2324 Map

Mailing address

75 Conant Rd
Quincy, MA 02171-1805

Specialties and licenses

TaxonomyCodeLicense
General Practice Dentistry Primary 1223G0001XNone listed

General Practice Dentistry: A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs.

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About NPI 1841194412

Form Dentistry PLLC's National Provider Identifier is 1841194412, issued on Oct 6, 2026. The primary taxonomy on file is General Practice Dentistry (1223G0001X), and the practice location is in Waltham, MA. The record was last updated on Oct 27, 2026.