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General NPI Number Information
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NPI Number | 1609279835
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Entity Type | Organization
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Legal Business Name | CAPE COD PEDIATRIC DENTISTRY, INC.
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Dates
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Enumeration Date | 10/02/2014
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Last Update Date | 10/02/2014
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Provider Practice Location Address
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Address Line | 89 LEWIS BAY RD SUITE 1
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City | HYANNIS
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State | MA
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Zip | 02601-5240
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Country | US
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Telephone | 508-737-0816
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Fax |
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Provider Business Mailing Address
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Address Line | 89 LEWIS BAY RD SUITE 1
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City | HYANNIS
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State | MA
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Zip | 02601-5240
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Country | US
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Telephone | 508-737-0816
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Fax |
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Authorized Official
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Title or Position | PEDIATRIC DENTIST
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Name | DR. AMY L FUGATE
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Credential | D.M.D.
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Telephone | 401-378-3720
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | DN1855409
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License Number State | MA
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