Healthcare Provider Details

I. General information

NPI: 1700121449
Provider Name (Legal Business Name): JOANNE MANY,DMD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2012
Last Update Date: 12/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

124 BOARDMAN ST
NORFOLK MA
02056-1051
US

IV. Provider business mailing address

124 BOARDMAN ST
NORFOLK MA
02056-1051
US

V. Phone/Fax

Practice location:
  • Phone: 508-520-9225
  • Fax: 508-520-9863
Mailing address:
  • Phone: 508-520-9225
  • Fax: 508-520-9863

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code126800000X
TaxonomyDental Assistant
License Number
License Number State

VIII. Authorized Official

Name: DR. JOANNE MANY
Title or Position: OWNER
Credential: DMD
Phone: 508-520-9225