MEDICARE: NORFOLK COUNTY DENTAL ASSOCIATES, LLC

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	14935	MA

General Provider Information

NPI Number	:	1235187360
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORFOLK COUNTY DENTAL ASSOCIATES, LLC

Provider Business Mailing Address
First Line	:	PO BOX 301
Second Line	:	158 MAIN ST
City	:	NORFOLK
State	:	MA
Zip	:	02056
Country	:	US
Telephone Number	:	508-528-6510
Fax Number	:	508-541-7937

Provider Business Practice Location Address
First Line	:	158 MAIN ST
Second Line	:
City	:	NORFOLK
State	:	MA
Zip	:	02056-1301
Country	:	US
Telephone Number	:	508-528-6510
Fax Number	:	508-541-7937

Authorized Official
Title or Position	:	OWNER
Name	:	DR. DAVID MICHAEL IADAROLA
Credential	:	DMD
Telephone Number	:	508-528-6510

Provider Enumeration Date	:	05/04/2006
Last Update Date	:	02/18/2013

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