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General NPI Number Information
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NPI Number | 1013071729
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Entity Type | Individual
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Provider Name | MARYJANE VAILLANCOURT DMD
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Gender | Female
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Dates
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Enumeration Date | 12/20/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 33 JAMES REYNOLDS RD
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City | SWANSEA
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State | MA
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Zip | 02777-3429
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Country | US
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Telephone | 508-379-0272
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Fax | 508-379-0272
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Provider Business Mailing Address
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Address Line | 42 PLEASANT ST P.O. BOX 733
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City | REHOBOTH
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State | MA
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Zip | 02769-2209
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Country | US
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Telephone | 508-252-6251
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 16896
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License Number State | MA
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