Healthcare Provider Details

I. General information

NPI: 1609081371
Provider Name (Legal Business Name): MICHAEL JOHN PRYHARSKI D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

57 E MAIN ST
WESTBOROUGH MA
01581-1464
US

IV. Provider business mailing address

57 E MAIN ST
WESTBOROUGH MA
01581-1464
US

V. Phone/Fax

Practice location:
  • Phone: 508-898-2515
  • Fax: 508-836-2682
Mailing address:
  • Phone: 508-898-2515
  • Fax: 508-836-2682

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number15918
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: