MEDICARE: JAMES M PHELAN DMD PC

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	122300000X	Dentist

General Provider Information

NPI Number	:	1326461682
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JAMES M PHELAN DMD PC

Provider Business Mailing Address
First Line	:	3 HOWARTH AVE
Second Line	:
City	:	SOUTH ATTLEBORO
State	:	MA
Zip	:	02703-5926
Country	:	US
Telephone Number	:	508-761-5320
Fax Number	:

Provider Business Practice Location Address
First Line	:	3 HOWARTH AVE
Second Line	:
City	:	SOUTH ATTLEBORO
State	:	MA
Zip	:	02703-5926
Country	:	US
Telephone Number	:	508-761-5320
Fax Number	:

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	DEBRA PHELAN
Credential	:
Telephone Number	:	508-761-5320

Provider Enumeration Date	:	01/22/2014
Last Update Date	:	01/22/2014

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