Healthcare Provider Details

I. General information

NPI: 1407263908
Provider Name (Legal Business Name): WORCESTER HILLS DENTAL PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2014
Last Update Date: 07/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

290 PARK AVE
WORCESTER MA
01609-1805
US

IV. Provider business mailing address

290 PARK AVE
WORCESTER MA
01609-1805
US

V. Phone/Fax

Practice location:
  • Phone: 508-798-9040
  • Fax: 508-798-9060
Mailing address:
  • Phone: 508-798-9040
  • Fax: 508-798-9060

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 Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State

VIII. Authorized Official

Name: MAREEN E GEORGE
Title or Position: DMD, OWNER
Credential: DMD
Phone: 508-798-9040