Healthcare Provider Details

I. General information

NPI: 1336262500
Provider Name (Legal Business Name): ADVANCED ROOT CANAL SPECAILISTS OF MA.,P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

154 HIGH ST
TAUNTON MA
02780-3556
US

IV. Provider business mailing address

154 HIGH ST
TAUNTON MA
02780-3556
US

V. Phone/Fax

Practice location:
  • Phone: 508-880-0801
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number17194
License Number StateMA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: ROBERT W. PASSLOFF
Title or Position: DENTIS
Credential:
Phone: 508-880-0801