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General NPI Number Information
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NPI Number | 1346753506
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Entity Type | Organization
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Legal Business Name | TEMPLE FAMILY DENTISTRY PLLC
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Dates
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Enumeration Date | 11/09/2017
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Last Update Date | 06/17/2023
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Provider Practice Location Address
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Address Line | 1261 FURNACE BROOK PKWY
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City | QUINCY
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State | MA
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Zip | 02169-4721
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Country | US
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Telephone | 909-553-7596
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Fax |
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Provider Business Mailing Address
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Address Line | 1261 FURNACE BROOK PKWY STE 12A
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City | QUINCY
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State | MA
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Zip | 02169-4762
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Country | US
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Telephone | 617-472-3700
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | STACY TEMPLE
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Credential | DMD
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Telephone | 617-472-3700
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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 | DN1855737
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License Number State | MA
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