=====================================================
General NPI Number Information
=====================================================
NPI Number | 1265735708
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ROBERT M. MCCARTHY, D.M.D. ,P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/06/2010
-----------------------------------------------------
Last Update Date | 12/06/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 548 PLEASANT ST
-----------------------------------------------------
City | WORCESTER
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01602-2754
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 508-756-6325
-----------------------------------------------------
Fax | 508-756-3086
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 548 PLEASANT ST
-----------------------------------------------------
City | WORCESTER
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01602-2754
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 508-756-6325
-----------------------------------------------------
Fax | 508-756-3086
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. ROBERT M. MCCARTHY
-----------------------------------------------------
Credential | D.M.D.
-----------------------------------------------------
Telephone | 508-756-6325
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QD0000X
-----------------------------------------------------
Taxonomy Name | Dental Clinic/Center
-----------------------------------------------------
License Number | 14192
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------