Healthcare Provider Details

I. General information

NPI: 1992914139
Provider Name (Legal Business Name): NASHAWAY DENTAL GROUP P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 07/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

131 MAIN STREET
SOUTH LANCASTER MA
01561
US

IV. Provider business mailing address

131 MAIN STREET P.O. BOX 606
SOUTH LANCASTER MA
01561
US

V. Phone/Fax

Practice location:
  • Phone: 978-365-5643
  • Fax: 978-368-0145
Mailing address:
  • Phone: 978-365-5643
  • Fax: 978-368-0145

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number11331
License Number StateMA

VIII. Authorized Official

Name: MS. MICHELE A. CADORET
Title or Position: OFFICE MANAGER
Credential:
Phone: 978-365-5643