Healthcare Provider Details

I. General information

NPI: 1417048117
Provider Name (Legal Business Name): CENTRAL DENTAL ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

47 CENTRAL ST
NORWOOD MA
02062
US

IV. Provider business mailing address

47 CENTRAL ST
NORWOOD MA
02062
US

V. Phone/Fax

Practice location:
  • Phone: 781-769-3566
  • Fax: 781-769-0992
Mailing address:
  • Phone: 781-769-3566
  • Fax: 781-769-0992

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number17718
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number15645
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number18350
License Number StateMA
# 4
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number17964
License Number StateMA

VIII. Authorized Official

Name: DR. ROBERT L VIVENTI
Title or Position: OWNER
Credential: DMD
Phone: 781-769-3566