Healthcare Provider Details

I. General information

NPI: 1467487199
Provider Name (Legal Business Name): ROBERT WILLARD FAILING D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5201 LEE RD
BUZZARDS BAY MA
02542-1313
US

IV. Provider business mailing address

14 PLEASANT WOOD DR
FORESTDALE MA
02644-1228
US

V. Phone/Fax

Practice location:
  • Phone: 508-968-6726
  • Fax: 508-968-6581
Mailing address:
  • Phone: 508-477-3409
  • Fax: 508-968-6581

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License NumberDS024246L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: