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General NPI Number Information
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NPI Number | 1215795521
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Entity Type | Organization
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Legal Business Name | DOVETAIL PAC RI
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Dates
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Enumeration Date | 03/11/2024
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Last Update Date | 09/23/2025
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Provider Practice Location Address
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Address Line | 3 ALLIED DR STE 303
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City | DEDHAM
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State | MA
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Zip | 02026-6148
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Country | US
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Telephone | 781-653-6951
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Fax | 781-205-1543
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Provider Business Mailing Address
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Address Line | 3 ALLIED DR STE 303
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City | DEDHAM
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State | MA
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Zip | 02026-6148
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Country | US
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Telephone | 781-653-6951
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Fax | 781-205-1543
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Authorized Official
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Title or Position | AUTHORIZED OFFICIAL
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Name | INDIA MICHEL
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Credential |
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Telephone | 781-653-6951
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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