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General NPI Number Information
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NPI Number | 1275753741
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Entity Type | Organization
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Legal Business Name | CHELMSFORD DENTAL ASSOCIATES
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Dates
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Enumeration Date | 04/26/2007
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Last Update Date | 09/19/2007
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Provider Practice Location Address
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Address Line | 18 NORTH RD
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City | CHELMSFORD
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State | MA
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Zip | 01824-2718
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Country | US
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Telephone | 978-256-2561
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Fax | 978-256-5529
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Provider Business Mailing Address
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Address Line | 18 NORTH RD
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City | CHELMSFORD
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State | MA
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Zip | 01824-2718
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Country | US
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Telephone | 978-256-2561
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Fax | 978-256-5529
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Authorized Official
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Title or Position | PARTNER OWNER
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Name | DR. DANIEL LAWRENCE FADJO
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Credential | DDS
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Telephone | 978-256-2561
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 12888
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License Number State | MA
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