Healthcare Provider Details

I. General information

NPI: 1932226594
Provider Name (Legal Business Name): DENTAL SPECIALTY PARTNERS OF NEW ENGLAND
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 COCHITUATE RD SUITE 304
FRAMINGHAM MA
01701-4648
US

IV. Provider business mailing address

405 COCHITUATE RD SUITE 304
FRAMINGHAM MA
01701-4648
US

V. Phone/Fax

Practice location:
  • Phone: 508-424-2525
  • Fax: 508-424-2528
Mailing address:
  • Phone: 508-424-2525
  • Fax: 508-424-2528

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number16291
License Number StateMA

VIII. Authorized Official

Name: DIANE PINTO
Title or Position: BUSINESS MANAGER
Credential:
Phone: 508-424-2525