Healthcare Provider Details

I. General information

NPI: 1609103795
Provider Name (Legal Business Name): CHILDREN'S DENTAL ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/10/2009
Last Update Date: 11/10/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 HIGH ST
MEDFORD MA
02155-3872
US

IV. Provider business mailing address

80 HIGH STREET
MEDFORD MA
02155
US

V. Phone/Fax

Practice location:
  • Phone: 781-391-8300
  • Fax:
Mailing address:
  • Phone: 781-391-8300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. ROBERT FRANK
Title or Position: PRESIDENT
Credential: DMD
Phone: 781-391-8300