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General NPI Number Information
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NPI Number | 1396939583
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Entity Type | Organization
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Legal Business Name | CHILDREN'S DENTISTRY OF NORTHBOROUGH
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Dates
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Enumeration Date | 08/30/2007
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Last Update Date | 11/21/2007
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Provider Practice Location Address
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Address Line | 38 SW CUTOFF SUITE D
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City | NORTHBOROUGH
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State | MA
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Zip | 01532-2159
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Country | US
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Telephone | 508-393-9394
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Fax | 508-393-9364
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Provider Business Mailing Address
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Address Line | 38 SW CUTOFF SUITE D
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City | NORTHBOROUGH
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State | MA
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Zip | 01532-2159
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Country | US
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Telephone | 508-393-9394
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Fax | 508-393-9364
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Authorized Official
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Title or Position | PEDIATRIC DENTIST
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Name | DR. JOLANTA MARIA MACDONALD
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Credential | D.M.D
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Telephone | 508-393-9394
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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 | 20433
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License Number State | MA
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