Healthcare Provider Details

I. General information

NPI: 1508823030
Provider Name (Legal Business Name): JOY-ANN SIMONE DEANE D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2006
Last Update Date: 02/26/2023
Certification Date: 02/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 MAIN ST STE 1
MARLBOROUGH MA
01752-3811
US

IV. Provider business mailing address

50 SHREWSBURY ST
WEST BOYLSTON MA
01583-2104
US

V. Phone/Fax

Practice location:
  • Phone: 508-485-2001
  • Fax:
Mailing address:
  • Phone: 508-425-4127
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number19216
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: