Healthcare Provider Details

I. General information

NPI: 1427870294
Provider Name (Legal Business Name): THOMAS P RAFFERTY DDS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2024
Last Update Date: 10/31/2024
Certification Date: 10/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

495 CABOT ST
BEVERLY MA
01915-1179
US

IV. Provider business mailing address

495 CABOT ST UNIT 301
BEVERLY MA
01915-1179
US

V. Phone/Fax

Practice location:
  • Phone: 978-777-1670
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. THOMAS RAFFERTY
Title or Position: OWNER
Credential:
Phone: 978-777-1670