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General NPI Number Information
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NPI Number | 1861833055
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Entity Type | Organization
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Legal Business Name | VILLAGE DENTAL GROUP, PC
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Dates
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Enumeration Date | 07/16/2013
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Last Update Date | 07/16/2013
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Provider Practice Location Address
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Address Line | 622 MAIN ST
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City | SHREWSBURY
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State | MA
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Zip | 01545-5639
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Country | US
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Telephone | 508-845-1156
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Fax | 508-845-1157
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Provider Business Mailing Address
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Address Line | 622 MAIN ST
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City | SHREWSBURY
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State | MA
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Zip | 01545-5639
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Country | US
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Telephone | 508-845-1156
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Fax | 508-845-1157
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Authorized Official
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Title or Position | PRESIDENT
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Name | NICHOLAS THEODORE PAPAPETROS
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Credential | D.M.D.
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Telephone | 508-845-1156
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 18093
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License Number State | MA
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