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General NPI Number Information
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NPI Number | 1053517037
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Entity Type | Organization
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Legal Business Name | PROSTHODONTICS, P.C.
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Dates
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Enumeration Date | 06/26/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 16 ENON ST
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City | BEVERLY
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State | MA
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Zip | 01915-1116
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Country | US
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Telephone | 978-922-6726
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Fax | 978-922-6727
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Provider Business Mailing Address
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Address Line | 16 ENON ST
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City | BEVERLY
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State | MA
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Zip | 01915-1116
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Country | US
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Telephone | 978-922-6726
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Fax | 978-922-6727
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MS. MARY-LOU COURCELLE
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Credential |
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Telephone | 978-922-6726
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0700X
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Taxonomy Name | Prosthodontics
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License Number | 17559
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License Number State | MA
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