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General NPI Number Information
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NPI Number | 1144472176
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Entity Type | Organization
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Legal Business Name | COSMETIC & FAMILY DENTISTRY ASSOC., INC
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Dates
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Enumeration Date | 10/22/2008
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Last Update Date | 10/14/2013
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Provider Practice Location Address
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Address Line | 580 MACARTHUR BLVD
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City | POCASSET
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State | MA
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Zip | 02559
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Country | US
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Telephone | 508-564-6663
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Fax | 508-564-6610
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Provider Business Mailing Address
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Address Line | 580 MACARTHUR BLVD
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City | BUZZARDS BAY
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State | MA
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Zip | 02532
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Country | US
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Telephone | 508-564-6663
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Fax | 508-564-6610
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Authorized Official
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Title or Position | DENTIST
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Name | DR. TRACY LYNN MURPHY
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Credential | DMD
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Telephone | 508-564-6663
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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 | 19530
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License Number State | MA
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