Healthcare Provider Details

I. General information

NPI: 1114486677
Provider Name (Legal Business Name): HAWTHORN FAMILY DENTAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2019
Last Update Date: 03/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

530 HAWTHORN ST
N DARTMOUTH MA
02747-3717
US

IV. Provider business mailing address

149 ROCK-O-DUNDEE RD
SO DARTMOUTH MA
02748
US

V. Phone/Fax

Practice location:
  • Phone: 508-994-5443
  • Fax:
Mailing address:
  • Phone: 508-965-2595
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. JOSPEH MILLS
Title or Position: OWNER
Credential: DMD
Phone: 508-994-5443