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General NPI Number Information
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NPI Number | 1396120689
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Entity Type | Organization
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Legal Business Name | LENNON STREET DENTAL ASSOCIATES PLLC
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Dates
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Enumeration Date | 07/28/2015
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Last Update Date | 07/28/2015
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Provider Practice Location Address
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Address Line | 39 LENNON ST
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City | GARDNER
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State | MA
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Zip | 01440-3907
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Country | US
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Telephone | 978-632-5502
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Fax | 978-632-0964
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Provider Business Mailing Address
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Address Line | 39 LENNON ST
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City | GARDNER
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State | MA
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Zip | 01440-3907
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Country | US
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Telephone | 978-632-5502
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Fax | 978-632-0964
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Authorized Official
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Title or Position | DENTIST
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Name | HARVEY APOTHEKER
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Credential | DMD
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Telephone | 978-632-5502
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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 | 13152
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License Number State | MA
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