Healthcare Provider Details

I. General information

NPI: 1841852126
Provider Name (Legal Business Name): MOYNIHAN DENTAL SPECIALISTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2019
Last Update Date: 07/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29 SOUTH ST
NORTHBOROUGH MA
01532-2603
US

IV. Provider business mailing address

258 MAIN ST STE 304
MILFORD MA
01757-2528
US

V. Phone/Fax

Practice location:
  • Phone: 508-393-7495
  • Fax:
Mailing address:
  • Phone: 508-473-8000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code292200000X
TaxonomyDental Laboratory
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL F. MOYNIHAN
Title or Position: OWNER
Credential: DMD
Phone: 508-393-7495