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General NPI Number Information
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NPI Number | 1467676379
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Entity Type | Organization
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Legal Business Name | PEDIATRIC DENTISTRY AND ORTHODONTICS OF THE NORTH SHORE L.L.C.
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Dates
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Enumeration Date | 04/12/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 6 STATE RD
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City | DANVERS
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State | MA
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Zip | 01923-2567
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Country | US
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Telephone | 978-774-1822
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Fax | 978-774-1734
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Provider Business Mailing Address
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Address Line | 6 STATE RD
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City | DANVERS
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State | MA
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Zip | 01923-2567
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Country | US
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Telephone | 978-774-1822
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Fax | 978-774-1734
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Authorized Official
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Title or Position | FINANCIAL COORDINATOR
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Name | MRS. CATHY REED
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Credential |
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Telephone | 978-774-1822
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 11337
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License Number State | MA
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