Healthcare Provider Details

I. General information

NPI: 1760870232
Provider Name (Legal Business Name): SCITUATE FAMILY DENTISTRY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/06/2015
Last Update Date: 01/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

56 NEW DRIFTWAY SUITE 205
SCITUATE MA
02066-4533
US

IV. Provider business mailing address

56 NEW DRIFTWAY SUITE 205
SCITUATE MA
02066-4533
US

V. Phone/Fax

Practice location:
  • Phone: 781-545-3703
  • Fax: 781-545-0772
Mailing address:
  • Phone: 781-545-3703
  • Fax: 781-545-0772

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberDN22290
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberDN15759
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. STEPHEN C HOFF
Title or Position: CEO
Credential: DMD
Phone: 781-545-3703