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General NPI Number Information
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NPI Number | 1992203111
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Entity Type | Organization
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Legal Business Name | SPROUT KIDS DENTISTRY OF QUINCY, LLC
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Dates
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Enumeration Date | 01/23/2018
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Last Update Date | 01/23/2018
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Provider Practice Location Address
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Address Line | 1250 HANCOCK ST STE 110N-B
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City | QUINCY
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State | MA
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Zip | 02169-4339
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Country | US
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Telephone | 617-947-6557
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Fax |
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Provider Business Mailing Address
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Address Line | 1250 HANCOCK ST STE 110N-B
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City | QUINCY
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State | MA
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Zip | 02169-4339
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Country | US
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Telephone | 617-947-6557
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Fax |
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Authorized Official
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Title or Position | OWNER/ DENTIST
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Name | DR. MICHELLE ANDERSON
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Credential | DMD
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Telephone | 617-947-6557
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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 |
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License Number State |
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