COMMONWEALTH DENTAL GROUP – NPI #1114533866
Clinic/Center

COMMONWEALTH DENTAL GROUP is an AHC clinic located in BOSTON, MA. NPPES has assigned the NPI number 1114533866 to COMMONWEALTH DENTAL GROUP on September 18, 2020. It is a Type-2 NPI, indicating this NPI number is associated with an organization. Since the name “COMMONWEALTH DENTAL GROUP” is a dba name, the actual legal business name for this organization is CDG BACK BAY LLC. The primary taxonomy selected by this provider is 261QD0000X from the Health Care Provider Taxonomy code set, which is classified as Clinic/Center, specializing in Dental

The NPI profile was last updated on Oct 27, 2024. Use the NPI data found here to bill health insurance companies, identify providers enrolled in Medicare and Medicaid services or other HIPAA compliant transactions. See the complete NPI profile for COMMONWEALTH DENTAL GROUP below.

NPI Profile for
CDG BACK BAY LLC

NPI Number
1114533866
Enumeration Date

(more than 5 years ago)
Entity Type
Type-2  Organization
Organization health care providers may have a single employee or thousands of employees. An example is an incorporated individual who is an organization's only employee.
Legal Name
CDG BACK BAY LLC
Doing Business As (dba): COMMONWEALTH DENTAL GROUP
Primary location
400 COMMONWEALTH AVE 3RD FLOOR
BOSTON, MA 02215
Phone: (617) 266-8770 Fax: (617) 266-9530
Mailing address
Same as primary location
Organization Subpart
No
Authorized Official
KOSTANTINA GIANNACOPOULOS
DENTAL DIRECTOR
Phone: (617) 266-8770
Updated
Certification Date
Oct 27, 2024

Note: NPPES allows providers to attest to the accuracy of their NPI data. When a provider request any change to the NPI record, they will be able to attest to their changed NPI data, resulting in an updated certification date.

Taxonomy Code(s)

A taxonomy code is a code that describes the health care service provider's type, classification, and the area of specialization. The primary specialty for this provider is indicated as (Primary) below.

Taxonomy Classification / Specialization State License
261QD0000X
- Clinic/Center / Dental (Primary)

The taxonomy codes are selected by the provider at the time of NPI registration. Selection of a taxonomy code does not replace any credentialing or validation process that the provider requesting the code should complete.