MEDICARE: SOUTHCOAST COMMUNITY DENTAL CARE

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
1	261QD0000X	Dental Clinic/Center	DH14025	MA
2	261QD0000X	Dental Clinic/Center	DH13264	MA

General Provider Information

NPI Number	:	1598186645
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHCOAST COMMUNITY DENTAL CARE

Provider Business Mailing Address
First Line	:	603 NEW BEDFORD RD
Second Line	:	PO BOX 22
City	:	ROCHESTER
State	:	MA
Zip	:	02770-4125
Country	:	US
Telephone Number	:	774-451-2067
Fax Number	:

Provider Business Practice Location Address
First Line	:	603 NEW BEDFORD RD
Second Line	:
City	:	ROCHESTER
State	:	MA
Zip	:	02770-4125
Country	:	US
Telephone Number	:	774-451-2067
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MELISSA LEITE
Credential	:
Telephone Number	:	774-451-2067

Provider Enumeration Date	:	12/16/2013
Last Update Date	:	12/16/2013

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Directions to “SOUTHCOAST COMMUNITY DENTAL CARE ” Practice Location

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