Healthcare Provider Details

I. General information

NPI: 1083895924
Provider Name (Legal Business Name): PETER T MESSIER DDS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2007
Last Update Date: 11/20/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

259 CENTER ST
MIDDLEBORO MA
02346
US

IV. Provider business mailing address

259 CENTER ST
MIDDLEBORO MA
02346
US

V. Phone/Fax

Practice location:
  • Phone: 508-947-7758
  • Fax: 508-947-0029
Mailing address:
  • Phone: 508-947-7758
  • Fax: 508-947-0029

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number11498
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number11004
License Number StateMA

VIII. Authorized Official

Name: DR. PETER TAIT MESSIER
Title or Position: PRESIDENT
Credential: DDS
Phone: 508-947-7758