MEDICARE: DAVID E PRINDIVILLE DMD

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	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	DN1856152	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	DN1856152	OTHER	MA	MASSACHUSETTS

General Provider Information

NPI Number	:	1588625727
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID E PRINDIVILLE DMD

Provider Business Mailing Address
First Line	:	247 FOSTER RD
Second Line	:
City	:	BREWSTER
State	:	MA
Zip	:	02631-1471
Country	:	US
Telephone Number	:	860-558-6786
Fax Number	:

Provider Business Practice Location Address
First Line	:	1 KNEELAND ST
Second Line	:
City	:	BOSTON
State	:	MA
Zip	:	02111-1527
Country	:	US
Telephone Number	:	617-636-6828
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/29/2006
Last Update Date	:	11/10/2025

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Directions to “ DAVID E PRINDIVILLE DMD” Practice Location

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