Healthcare Provider Details

I. General information

NPI: 1316318686
Provider Name (Legal Business Name): OUTER CAPE DENTAL GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2015
Last Update Date: 10/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 CANNON HILL RD
SOUTH WELLFLEET MA
02663
US

IV. Provider business mailing address

PO BOX 700 10 CANNON HILL RD
SOUTH WELLFLEET MA
02663-0700
US

V. Phone/Fax

Practice location:
  • Phone: 508-349-6300
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN21625
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License NumberDN14506
License Number StateMA

VIII. Authorized Official

Name: DR. KEVIN F. TOOMEY
Title or Position: CO-OWNER
Credential: D.M.D.
Phone: 508-349-6300