Healthcare Provider Details

I. General information

NPI: 1700283074
Provider Name (Legal Business Name): STERLING DENTAL GROUP P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/02/2014
Last Update Date: 12/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 BEVERLY DR
STERLING MA
01564-2150
US

IV. Provider business mailing address

2 BEVERLY DR
STERLING MA
01564-2150
US

V. Phone/Fax

Practice location:
  • Phone: 978-422-6152
  • Fax:
Mailing address:
  • Phone: 978-422-6152
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number12677
License Number StateMA
# 3
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number
License Number StateMA

VIII. Authorized Official

Name: JOSIE S SANTOS
Title or Position: OFFICE MANAGER
Credential:
Phone: 508-832-5731