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General NPI Number Information
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NPI Number | 1396829180
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Entity Type | Organization
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Legal Business Name | EUGENE A MICKEY, DMD, MPH, PC
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Dates
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Enumeration Date | 10/25/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 67 MONTVALE AVE SUITE 101
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City | STONEHAM
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State | MA
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Zip | 02180-3618
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Country | US
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Telephone | 781-279-2400
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Fax | 781-279-4640
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Provider Business Mailing Address
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Address Line | 67 MONTVALE AVE SUITE 101
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City | STONEHAM
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State | MA
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Zip | 02180-3618
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Country | US
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Telephone | 781-279-2400
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Fax | 781-279-4640
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. LISA A FIELD
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Credential | CDPMA
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Telephone | 781-279-2400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 14275
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License Number State | MA
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