MEDICARE: FAMILY DENTAL CARE, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	12207	MA
2	1223G0001X	General Practice Dentistry	11878	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1144254087
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAMILY DENTAL CARE, INC

Provider Business Mailing Address
First Line	:	1444 DORCHESTER AVE
Second Line	:
City	:	DORCHESTER
State	:	MA
Zip	:	02122-2922
Country	:	US
Telephone Number	:	617-436-7030
Fax Number	:	617-265-7295

Provider Business Practice Location Address
First Line	:	1444 DORCHESTER AVE
Second Line	:
City	:	DORCHESTER
State	:	MA
Zip	:	02122-2922
Country	:	US
Telephone Number	:	617-436-7030
Fax Number	:	617-265-7295

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. MORRIS COHEN
Credential	:	D.M.D.
Telephone Number	:	617-436-6782

Provider Enumeration Date	:	07/10/2006
Last Update Date	:	06/24/2008

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Directions to “FAMILY DENTAL CARE, INC ” Practice Location

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