Healthcare Provider Details

I. General information

NPI: 1184835365
Provider Name (Legal Business Name): HOPKINTON DENTAL ASSOCIATES, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

77 W MAIN ST SUITE 210
HOPKINTON MA
01748-1684
US

IV. Provider business mailing address

77 W MAIN ST SUITE 210
HOPKINTON MA
01748-1684
US

V. Phone/Fax

Practice location:
  • Phone: 508-435-5455
  • Fax: 508-435-9499
Mailing address:
  • Phone: 508-435-5455
  • Fax: 508-435-9499

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number20976
License Number StateMA

VIII. Authorized Official

Name: DR. JOHN C PARK
Title or Position: PRESIDENT
Credential: D.M.D.
Phone: 508-435-5455