Healthcare Provider Details

I. General information

NPI: 1225348428
Provider Name (Legal Business Name): DENTZZ DENTAL LIMITED PARTNERSHIP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/21/2010
Last Update Date: 10/21/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

427 PLYMOUTH AVENUE
FALL RIVER MA
02721-4231
US

IV. Provider business mailing address

427 PLYMOUTH AVENUE
FALL RIVER MA
02721-4231
US

V. Phone/Fax

Practice location:
  • Phone: 508-679-0010
  • Fax: 508-672-4679
Mailing address:
  • Phone: 508-679-0010
  • Fax: 508-672-4679

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN1855087
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN1855087
License Number StateMA

VIII. Authorized Official

Name: MRS. CAROL A HABIB
Title or Position: MANAGER
Credential:
Phone: 508-679-0010