Provider Demographics
NPI:1366609307
Name:HARVARD STREET DENTAL PC
Entity type:Organization
Organization Name:HARVARD STREET DENTAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:P
Authorized Official - Last Name:FOLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:617-492-3535
Mailing Address - Street 1:287 HARVARD ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02139-2383
Mailing Address - Country:US
Mailing Address - Phone:617-492-3535
Mailing Address - Fax:617-876-1303
Practice Address - Street 1:287 HARVARD ST
Practice Address - Street 2:SUITE 1
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02139-2383
Practice Address - Country:US
Practice Address - Phone:617-492-3535
Practice Address - Fax:617-876-1303
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-19
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA21329261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental