=====================================================
General NPI Number Information
=====================================================
NPI Number | 1497228498
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WESTWOOD DENTAL ASSOCIATES, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/02/2019
-----------------------------------------------------
Last Update Date | 01/02/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 541 HIGH ST STE 3
-----------------------------------------------------
City | WESTWOOD
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02090-1628
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 781-326-2133
-----------------------------------------------------
Fax | 781-320-8775
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 14 SHELDON RD
-----------------------------------------------------
City | MARBLEHEAD
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01945-2025
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 781-366-3804
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PERIODONTIST/PARTNER
-----------------------------------------------------
Name | DR. MICHELE CROHIN
-----------------------------------------------------
Credential | DMD
-----------------------------------------------------
Telephone | 781-366-3804
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223E0200X
-----------------------------------------------------
Taxonomy Name | Endodontics
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 1223P0300X
-----------------------------------------------------
Taxonomy Name | Periodontics
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 1223P0700X
-----------------------------------------------------
Taxonomy Name | Prosthodontics
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------