Healthcare Provider Details

I. General information

NPI: 1588784219
Provider Name (Legal Business Name): PEDIATRIC DENTAL HEALTHCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 WASHINGTON ST
PLAINVILLE MA
02762-2641
US

IV. Provider business mailing address

16 WASHINGTON ST
PLAINVILLE MA
02762-2641
US

V. Phone/Fax

Practice location:
  • Phone: 508-695-2064
  • Fax: 508-695-8492
Mailing address:
  • Phone: 508-695-2064
  • Fax: 508-695-8492

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number19182
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number19217
License Number StateMA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. PAULO NOGUEIRA
Title or Position: ORTHODONTIST, OWNER
Credential: D.M.D,M.S.D
Phone: 508-695-2064