Healthcare Provider Details

I. General information

NPI: 1700203106
Provider Name (Legal Business Name): VARINOS DENTAL ASSOCIATES OF WINTHROP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/24/2014
Last Update Date: 03/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

185 HERMON ST
WINTHROP MA
02152-3024
US

IV. Provider business mailing address

185 HERMON ST
WINTHROP MA
02152-3024
US

V. Phone/Fax

Practice location:
  • Phone: 617-846-1280
  • Fax:
Mailing address:
  • Phone: 617-846-1280
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License NumberDN16578
License Number StateMA

VIII. Authorized Official

Name: RENEE MCKAIN
Title or Position: MANAGER
Credential:
Phone: 978-535-3800