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General NPI Number Information
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NPI Number | 1215416672
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Entity Type | Organization
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Legal Business Name | MALDEN DENTISTRY AND BRACES, P.C.
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Dates
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Enumeration Date | 08/07/2018
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Last Update Date | 04/23/2020
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Provider Practice Location Address
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Address Line | 427 MAIN ST
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City | MALDEN
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State | MA
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Zip | 02148-5012
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Country | US
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Telephone | 781-322-5070
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Fax |
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Provider Business Mailing Address
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Address Line | 5 MOUNT ROYAL AVE STE 300
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City | MARLBOROUGH
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State | MA
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Zip | 01752-1900
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Country | US
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Telephone | 508-460-0632
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Fax |
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Authorized Official
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Title or Position | CFO
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Name | MS. JOANNE TAVANO
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Credential |
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Telephone | 978-580-1524
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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 | DN20209
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License Number State | MA
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