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NPI Code Detail

MEDICARE: DR. ANDRE EUGENE ST GERMAIN DMD MSCD

MEDICARE: DR. ANDRE EUGENE ST GERMAIN DMD MSCD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1122300000XDentistDN106081MA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1DN106081OTHERMAMASS DENTAL LICENSE

General Provider Information

NPI Number : 1588794499
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ANDRE EUGENE ST GERMAIN DMD MSCD
Provider Business Mailing Address
First Line : PO BOX 151
Second Line : 30 FRANKLIN TERRACE
City : VINEYARD HAVEN
State : MA
Zip : 02568-0151
Country : US
Telephone Number : 508-693-0307
Fax Number :
Provider Business Practice Location Address
First Line : EMERALD ST
Second Line : TUFTS DENTAL FACILITY AT WRENTHAM
City : WRENTHAM
State : MA
Zip : 02093-1902
Country : US
Telephone Number : 508-384-8987
Fax Number : 508-384-6594
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/07/2007
Last Update Date : 07/08/2007

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