Healthcare Provider Details

I. General information

NPI: 1376453555
Provider Name (Legal Business Name): ADVANCED DENTAL BRANDS OF MA 4 PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2026
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 MAIN ST
PEPPERELL MA
01463-1527
US

IV. Provider business mailing address

75 MAIN ST
PEPPERELL MA
01463-1527
US

V. Phone/Fax

Practice location:
  • Phone: 978-433-3700
  • Fax:
Mailing address:
  • Phone: 978-433-3700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State

VIII. Authorized Official

Name: SARA BROWN
Title or Position: CREDENTIALING MANAGER
Credential:
Phone: 918-533-2934