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General NPI Number Information
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NPI Number | 1720369853
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Entity Type | Organization
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Legal Business Name | MILLBURY FAMILY DENTISTRY, P.C.
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Dates
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Enumeration Date | 09/02/2011
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Last Update Date | 09/02/2011
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Provider Practice Location Address
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Address Line | 116 MAIN ST.
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City | MILLBURY
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State | MA
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Zip | 01527-2021
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Country | US
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Telephone | 508-865-2622
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Fax | 508-865-1676
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Provider Business Mailing Address
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Address Line | 116 MAIN ST.
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City | MILLBURY
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State | MA
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Zip | 01527-2021
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Country | US
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Telephone | 508-865-2622
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Fax | 508-865-1676
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Authorized Official
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Title or Position | DENTIST
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Name | DR. DAVID M MATSON
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Credential | DMD
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Telephone | 508-865-2622
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DN1855061
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DN15100
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License Number State | MA
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