Basic Information
| Provider Information | |||||||||
| NPI: | 1952797797 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ALBIN | ||||||||
| FirstName: | MAXWELLE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8 FRED DOLAN CIR | ||||||||
| Address2: | |||||||||
| City: | RANDOLPH | ||||||||
| State: | MA | ||||||||
| PostalCode: | 023682854 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6174134401 | ||||||||
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| Practice Location | |||||||||
| Address1: | 632 BLUE HILL AVE | ||||||||
| Address2: | |||||||||
| City: | DORCHESTER | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021213213 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6178253400 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/08/2015 | ||||||||
| LastUpdateDate: | 04/08/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223G0001X | DF10980 | MA | Y | Dental Providers | Dentist | General Practice |
No ID Information.