Healthcare Provider Details

I. General information

NPI: 1669719902
Provider Name (Legal Business Name): PATRICIA J SARGEANT DDS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/07/2013
Last Update Date: 01/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

78 N MAIN ST REAR
ASSONET MA
02702-1017
US

IV. Provider business mailing address

POBOX 878
ASSONET MA
02702-0897
US

V. Phone/Fax

Practice location:
  • Phone: 508-644-2233
  • Fax: 508-644-2234
Mailing address:
  • Phone: 508-644-2233
  • Fax: 508-644-2234

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number16679
License Number StateMA

VIII. Authorized Official

Name: DR. PATRICIA J SARGEANT
Title or Position: DR
Credential: DDS
Phone: 508-644-2233