Healthcare Provider Details

I. General information

NPI: 1427025279
Provider Name (Legal Business Name): QUINCY DENTAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

875 SOUTHERN ARTERY
QUINCY MA
02169-7122
US

IV. Provider business mailing address

875 SOUTHERN ARTERY
QUINCY MA
02169-7122
US

V. Phone/Fax

Practice location:
  • Phone: 617-471-4449
  • Fax: 617-657-0775
Mailing address:
  • Phone: 617-471-4449
  • Fax: 617-657-0775

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number18200
License Number StateMA

VIII. Authorized Official

Name: DR. MARYANN THOMAS
Title or Position: DENTIST
Credential: DMD
Phone: 617-471-4449