Healthcare Provider Details

I. General information

NPI: 1609886720
Provider Name (Legal Business Name): DENTAL SURGEONS OF FALL RIVER, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2006
Last Update Date: 01/26/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 ELSBREE ST
FALL RIVER MA
02720-7212
US

IV. Provider business mailing address

180 ELSBREE ST
FALL RIVER MA
02720-7212
US

V. Phone/Fax

Practice location:
  • Phone: 508-672-1069
  • Fax: 508-672-3848
Mailing address:
  • Phone: 508-672-1069
  • Fax: 508-672-3848

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0106X
TaxonomyOral and Maxillofacial Pathology Dentistry
License Number18730
License Number StateMA

VIII. Authorized Official

Name: JOHN A MARSHALL
Title or Position: OWNER
Credential: D.M.D.
Phone: 508-672-1069