Healthcare Provider Details

I. General information

NPI: 1366158727
Provider Name (Legal Business Name): PEOPLESDENTAL, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/27/2023
Last Update Date: 01/27/2023
Certification Date: 01/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

372 WASHINGTON ST STE 2500
WELLESLEY MA
02481-6216
US

IV. Provider business mailing address

372 WASHINGTON ST STE 2500
WELLESLEY MA
02481-6216
US

V. Phone/Fax

Practice location:
  • Phone: 781-226-2440
  • Fax:
Mailing address:
  • Phone: 781-226-2440
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number
License Number State

VIII. Authorized Official

Name: LEAH ANN MAYLOTT
Title or Position: CREDENTIALING ADMINISTRATOR
Credential:
Phone: 860-874-8198