RUSSELL L FORMAN, DMD, PC (NPI# 1568831493) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1568831493 |
| Entity Type | Organization |
| Organization Name | RUSSELL L FORMAN, DMD, PC |
| Practice Address |
875 Massachusetts Ave Suite 63 Cambridge MA 02139-3067 |
| Practice Telephone | 6178685500 |
| Mailing Telephone | 6178685500 |
| Enumeration Date | 2015-09-22 |
| Last Update Date | 2015-09-22 |
| Authorized Official Name | DR. RUSSELL LANG FORMAN (OWNER) |
| Authorized Official Telephone | 6178685500 |
| Authorized Official Credential | D.M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QD0000X |
Clinic/Center Specialization: Dental |
DN18021 | MA | Ambulatory Health Care Facilities |
| Street Address |
875 MASSACHUSETTS AVE SUITE 63 |
| City | CAMBRIDGE |
| State | MA |
| Zip Code | 02139-3067 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679564108 | Sanda Soe Aung | Psychiatry & Neurology | 875 Massachusetts Ave, 75, Cambridge, MA 02139-3067 | 2005-11-03 |
| 1114533312 | Stacey Slate Pllc | Counselor | 875 Massachusetts Ave, Cambridge, MA 02139-3067 | 2020-09-22 |
| 1871900100 | Khristy Fontillas | Dentist | 875 Massachusetts Ave, Suite 63, Cambridge, MA 02139-3067 | 2014-07-18 |
| 1073948154 | Silvia Dominguez | Counselor | 875 Massachusetts Ave, Cambridge, MA 02139-3067 | 2013-09-09 |
| 1316387020 | Azimuth Psychological | Psychologist | 875 Massachusetts Ave, #21, Cambridge, MA 02139-3067 | 2013-06-26 |
| 1417392929 | Valerie Blanc | Counselor | 875 Massachusetts Ave, Suite 2-5, Cambridge, MA 02139-3067 | 2013-05-10 |
| 1508109083 | Shannon Kelly | Social Worker | 875 Massachusetts Ave, #61, Cambridge, MA 02139-3067 | 2013-04-03 |
| 1033453584 | Highland Psychological Associates, LLC | Psychologist | 875 Massachusetts Ave, Suite 71, Cambridge, MA 02139-3067 | 2012-11-23 |
| 1356698450 | Amy Lauren Mitchell | Psychologist | 875 Massachusetts Ave, Suite 61, Cambridge, MA 02139-3067 | 2012-08-07 |
| 1124385612 | Tammy S Smith | Counselor | 875 Massachusetts Ave, 25, Cambridge, MA 02139-3067 | 2012-04-20 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598316044 | Diane Greenleaf | Registered Nurse | Cha Windsor Clinic, 119 Windsor St, Cambridge, MA 02139 | 2019-09-26 |
| 1730738345 | Martin Bednar | Student in an Organized Health Care Education/Training Program | 350 Massachusetts Avenue, Cambridge, MA 02139 | 2019-09-06 |
| 1861050049 | Rebecca Marie Addison | Dietitian, Registered | 75 Auburn St, Cambridge, MA 02139 | 2019-06-03 |
| 1285103051 | Jenna Halloran | Social Worker | 929 Massaschusetts Ave, Cambridge, MA 02139 | 2018-11-21 |
| 1750859286 | Lisa Marie Keovongsa | Dietitian, Registered | 186 1/2 Hampshire St., Cambridge, MA 02139 | 2018-11-02 |
| 1245714237 | Eleanor Coffin | Occupational Therapist | 1483 Cambridge St, Cambridge, MA 02139 | 2018-09-17 |
| 1649758277 | Sariya Idriss | Social Worker | Cambridge Health Alliance, 1493 Cambridge St., Cambridge, MA 02139 | 2018-08-06 |
| 1538647151 | Ari Pehkonen | Social Worker | Cambridge Health Alliance, Cambridge Hospital, 1493 Cambridge St., Cambridge, MA 02139 | 2018-08-06 |
| 1972080893 | Esther Cazeau | Counselor | 237 Hampshire St., Cambridge, MA 02139 | 2018-07-24 |
| 1528596533 | Adam Liebling | Acupuncturist | 11 Fiske Pl., Cambridge, MA 02139 | 2017-06-03 |
| Find all providers in zip 02139 | ||||
| Taxonomy Code | 261QD0000X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Dental |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134496904 | Fresh Pond Dental LLC | Clinic/Center | 180 Alewife Brook Pkwy, Cambridge, MA 02138-1102 | 2011-11-22 |
| 1689957888 | Minnesota Sedation Dental | Clinic/Center | 1596 2nd Ave Ne, Suite B, Cambridge, MN 55008 | 2011-09-23 |
| 1669788253 | Lux Dental Care P.C. | Clinic/Center | 122 First Street, Cambridge, MA 02141 | 2010-08-20 |
| 1750521399 | Prospect Dental Group, L.L.C. | Clinic/Center | 30 Prospect St., Cambridge, MA 02139 | 2009-02-23 |
| 1710132154 | Alegria Dental Group, P.C. | Clinic/Center | 1058 Cambridge Street, Cambridge, MA 02139-1407 | 2008-11-26 |
| 1033363395 | Cambridge Dental Annex | Clinic/Center | 897 Massachusetts Ave, Cambridge, MA 02139-3045 | 2008-11-12 |
| 1952515181 | Albert R. Duarte, D.m.d., P.C. | Clinic/Center | 2130 Massachusetts Ave, Suite 1a, Cambridge, MA 02140-1927 | 2007-05-09 |
| 1366539082 | Matthew J Peterson, Dds, Pa | Clinic/Center | 124 1st Ave E, Cambridge, MN 55008-1209 | 2006-10-06 |
| 1164079810 | Andrew Schwartz-hinds Dmd Pllc | Clinic/Center | 825 Cambridge St, Cambridge, MA 02141-1429 | 2019-08-19 |
| 1033765953 | 42 North Dental Care, LLC | Clinic/Center | 180 Alewife Brook Pkwy, Cambridge, MA 02138-1102 | 2019-08-15 |
| Find all providers in CAMBRIDGE | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.