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General NPI Number Information
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NPI Number | 1407012271
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Entity Type | Organization
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Legal Business Name | NEWTONVILLE DENTAL ASSOCIATES, LLC
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Dates
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Enumeration Date | 07/31/2008
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Last Update Date | 08/01/2022
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Provider Practice Location Address
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Address Line | 701 WASHINGTON ST
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City | NEWTONVILLE
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State | MA
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Zip | 02458-1386
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Country | US
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Telephone | 617-558-8848
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Fax |
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Provider Business Mailing Address
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Address Line | 701 WASHINGTON ST
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City | NEWTONVILLE
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State | MA
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Zip | 02458-1386
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Country | US
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Telephone | 603-682-3086
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. SARAH JORDAN
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Credential | D.M.D.
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Telephone | 603-682-3086
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 19691
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License Number State | MA
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