Healthcare Provider Details

I. General information

NPI: 1225260276
Provider Name (Legal Business Name): CHILDRENS DENTAL ASSOCIATES (WESTFORD)
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2009
Last Update Date: 08/10/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 LITTLETON RD
WESTFORD MA
01886-3196
US

IV. Provider business mailing address

175 LITTLETON RD
WESTFORD MA
01886-3196
US

V. Phone/Fax

Practice location:
  • Phone: 978-392-9800
  • Fax:
Mailing address:
  • Phone: 978-392-9800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number10808
License Number StateMA

VIII. Authorized Official

Name: DR. ROBERT A. FRANK
Title or Position: PRESIDENT
Credential: DMD
Phone: 781-391-8300