=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376440602
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AVITA DENTAL ASSOCIATES PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/21/2026
-----------------------------------------------------
Last Update Date | 10/21/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 96 OLD BARNSTABLE RD
-----------------------------------------------------
City | MASHPEE
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02649-3296
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 508-477-0070
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 15 ARTISAN DR UNIT 647
-----------------------------------------------------
City | SALEM
-----------------------------------------------------
State | NH
-----------------------------------------------------
Zip | 03079-5026
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 508-759-2724
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | NICHOLAS THEODORE PAPAPETROS II
-----------------------------------------------------
Credential | DMD
-----------------------------------------------------
Telephone | 978-886-2678
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------