Healthcare Provider Details

I. General information

NPI: 1699911347
Provider Name (Legal Business Name): ATTLEBORO-CUMBERLAND ORAL SURGEONS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/31/2008
Last Update Date: 12/31/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 COMMONWEALTH AVE
ATTLEBORO FALLS MA
02763-1015
US

IV. Provider business mailing address

103 COMMONWEALTH AVE
ATTLEBORO FALLS MA
02763-1015
US

V. Phone/Fax

Practice location:
  • Phone: 508-699-0449
  • Fax: 508-699-4344
Mailing address:
  • Phone: 508-699-0449
  • Fax: 508-699-4344

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number21387
License Number StateMA

VIII. Authorized Official

Name: DR. MARK DAVID SCHENKMAN
Title or Position: PARTNER
Credential: D.D.S.
Phone: 508-699-0449