Healthcare Provider Details

I. General information

NPI: 1760997670
Provider Name (Legal Business Name): WESTBOROUGH DENTAL PARTNERS, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2017
Last Update Date: 04/23/2020
Certification Date: 04/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

176 E MAIN ST STE 2
WESTBOROUGH MA
01581
US

IV. Provider business mailing address

5 MOUNT ROYAL AVE STE 300
MARLBOROUGH MA
01752-1900
US

V. Phone/Fax

Practice location:
  • Phone: 508-366-8300
  • Fax: 508-870-1848
Mailing address:
  • Phone: 508-460-0632
  • Fax: 508-872-0781

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: MS. JOANNE TAVANO
Title or Position: CHIEF OPERATING OFFICER
Credential:
Phone: 978-580-1524