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General NPI Number Information
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NPI Number | 1437441508
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Entity Type | Organization
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Legal Business Name | MEDFIELD DENTAL
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Dates
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Enumeration Date | 05/09/2011
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Last Update Date | 05/09/2011
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Provider Practice Location Address
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Address Line | 36 JANES AVE
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City | MEDFIELD
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State | MA
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Zip | 02052-2005
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Country | US
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Telephone | 508-359-6900
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Fax | 508-359-7900
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Provider Business Mailing Address
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Address Line | 36 JANES AVE
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City | MEDFIELD
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State | MA
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Zip | 02052-2005
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Country | US
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Telephone | 508-359-6900
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Fax | 508-359-7900
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Authorized Official
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Title or Position | PRESIDENT
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Name | MARI BAE
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Credential | D.M.D.
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Telephone | 508-359-6900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 22201
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License Number State | MA
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