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General NPI Number Information
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NPI Number | 1922566041
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Entity Type | Organization
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Legal Business Name | ALLIANCE DENTAL CENTER, LLC
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Dates
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Enumeration Date | 03/07/2019
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Last Update Date | 01/05/2021
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Provider Practice Location Address
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Address Line | 111 WASHINGTON ST STE 301
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City | QUINCY
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State | MA
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Zip | 02169-5354
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Country | US
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Telephone | 617-984-5300
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Fax | 617-481-0905
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Provider Business Mailing Address
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Address Line | PO BOX 4114
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City | PEABODY
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State | MA
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Zip | 01961-4114
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Country | US
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Telephone | 617-426-5878
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | SUSAN FOURNIER
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Credential |
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Telephone | 617-426-5878
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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