Healthcare Provider Details

I. General information

NPI: 1306828660
Provider Name (Legal Business Name): COBB CORNER ENDODONTICS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

95 WASHINGTON ST STE 482
CANTON MA
02021-4006
US

IV. Provider business mailing address

95 WASHINGTON ST STE 482
CANTON MA
02021-4006
US

V. Phone/Fax

Practice location:
  • Phone: 781-575-9633
  • Fax: 781-575-0086
Mailing address:
  • Phone: 781-575-9633
  • Fax: 781-575-0086

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number20067
License Number StateMA

VIII. Authorized Official

Name: DR. ERIC LOUIS WEINSTOCK
Title or Position: PRESIDENT
Credential: DMD
Phone: 781-575-9633