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General NPI Number Information
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NPI Number | 1356878227
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Entity Type | Individual
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Provider Name | MARK ANTHONY MEDEIROS DMD
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Gender | Male
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Dates
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Enumeration Date | 05/22/2017
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 227 WASHINGTON ST
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City | ATTLEBORO
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State | MA
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Zip | 02703-5554
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Country | US
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Telephone | 774-282-4206
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Fax |
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Provider Business Mailing Address
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Address Line | 17 CONCORD RD
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City | STONEHAM
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State | MA
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Zip | 02180-2155
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | DN1857564
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License Number State | MA
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