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General NPI Number Information
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NPI Number | 1760755417
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Entity Type | Organization
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Legal Business Name | ADVANCED DENTAL PROFESSIONALS,PC
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Dates
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Enumeration Date | 02/10/2012
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Last Update Date | 02/10/2012
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Provider Practice Location Address
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Address Line | 413 BROADWAY STE 101
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City | METHUEN
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State | MA
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Zip | 01844
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Country | US
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Telephone | 978-258-3252
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Fax |
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Provider Business Mailing Address
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Address Line | 413 BROADWAY STE101
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City | METHUEN
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State | MA
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Zip | 01844
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Country | US
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Telephone | 978-258-3252
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | RANDALL L DAVIS
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Credential |
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Telephone | 978-258-3252
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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 | 16356
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License Number State | MA
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