Healthcare Provider Details

I. General information

NPI: 1548836240
Provider Name (Legal Business Name): HUDSON DENTISTRY AND BRACES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2021
Last Update Date: 06/02/2021
Certification Date: 05/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 HIGHLAND COMMONS UNIT 3656/21B
HUDSON MA
01749
US

IV. Provider business mailing address

5 MOUNT ROYAL AVE STE 300
MARLBOROUGH MA
01752-1900
US

V. Phone/Fax

Practice location:
  • Phone: 978-245-7700
  • Fax: 978-245-7701
Mailing address:
  • Phone: 508-872-3072
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: MS. JOANNE TAVANO
Title or Position: CFO
Credential:
Phone: 978-580-1524