Healthcare Provider Details

I. General information

NPI: 1407417546
Provider Name (Legal Business Name): EPIONE DENTAL ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2019
Last Update Date: 06/27/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1071 WORCESTER RD # 3B
FRAMINGHAM MA
01701-5247
US

IV. Provider business mailing address

1071 WORCESTER RD # 3B
FRAMINGHAM MA
01701-5247
US

V. Phone/Fax

Practice location:
  • Phone: 508-626-8338
  • Fax:
Mailing address:
  • Phone: 508-626-8338
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number
License Number State

VIII. Authorized Official

Name: SARAH STIPHO
Title or Position: OWNER
Credential: DMD
Phone: 508-626-8338