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General NPI Number Information
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NPI Number | 1134324866
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Entity Type | Organization
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Legal Business Name | KIDS DENTAL CARE OF FALL RIVER, PC
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Dates
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Enumeration Date | 06/21/2007
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Last Update Date | 06/24/2011
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Provider Practice Location Address
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Address Line | 154 W GROVE ST
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City | MIDDLEBORO
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State | MA
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Zip | 02346-1484
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Country | US
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Telephone | 508-947-6477
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1799
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City | NORTH FALMOUTH
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State | MA
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Zip | 02556-1799
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Country | US
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Telephone | 508-947-6477
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Fax |
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | DR. MICHAEL ANTHONY BUCCINO
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Credential | DDS, MSD
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Telephone | 508-947-6477
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 16809
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License Number State | MA
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