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General NPI Number Information
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NPI Number | 1417548116
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Entity Type | Organization
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Legal Business Name | HARBOR DENTAL ASSOCIATES P.C.
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Dates
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Enumeration Date | 01/27/2021
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Last Update Date | 09/13/2021
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Provider Practice Location Address
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Address Line | 2 HARRY KEMP WAY UNIT 2
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City | PROVINCETOWN
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State | MA
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Zip | 02657-1511
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Country | US
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Telephone | 508-241-6366
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Fax |
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Provider Business Mailing Address
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Address Line | 4 WILLOW DR APT 4
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City | PROVINCETOWN
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State | MA
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Zip | 02657-1638
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Country | US
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Telephone | 617-283-1220
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | JORGE A RODRIGUEZ
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Credential | DMD
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Telephone | 508-241-6366
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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 |
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License Number State |
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