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General NPI Number Information
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NPI Number | 1144747221
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Entity Type | Organization
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Legal Business Name | MINA SCHAFFT DMD PLLC
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Dates
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Enumeration Date | 08/29/2017
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Last Update Date | 08/29/2017
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Provider Practice Location Address
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Address Line | 321 WASHINGTON STREET UNIT 101
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City | WESTWOOD
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State | MA
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Zip | 02184
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Country | US
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Telephone | 781-686-9789
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Fax |
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Provider Business Mailing Address
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Address Line | 75 HOLLIS AVE
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City | BRAINTREE
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State | MA
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Zip | 02184-4634
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Country | US
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Telephone | 617-905-9580
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | GUILLERMINA SCHAFFT
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Credential | DMD
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Telephone | 617-905-9580
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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 | 21756
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License Number State | MA
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