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General NPI Number Information
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NPI Number | 1588761787
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Entity Type | Organization
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Legal Business Name | PROFESSIONAL ENDODONTICS PC
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Dates
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Enumeration Date | 09/20/2006
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Last Update Date | 10/22/2007
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Provider Practice Location Address
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Address Line | 30 HIGGINS CROWELL ROAD
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City | WEST YARMOUTH
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State | MA
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Zip | 02673
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Country | US
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Telephone | 508-771-3336
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Fax | 508-778-9210
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Provider Business Mailing Address
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Address Line | 30 HIGGINS CROWELL ROAD
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City | WEST YARMOUTH
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State | MA
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Zip | 02673
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Country | US
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Telephone | 508-771-3336
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Fax | 508-778-9210
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Authorized Official
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Title or Position | OWNER
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Name | DANIEL J MOLLOY
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Credential | DMD
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Telephone | 508-771-3336
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | 17951
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | 16568
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License Number State | MA
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