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NPI Code Detail

MEDICARE: DILLAWAY FAMILY DENTISTRY, P.C.

MEDICARE: DILLAWAY FAMILY DENTISTRY, P.C.
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
11223G0001XGeneral Practice Dentistry

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1X10346DIOTHERMABLUE CROSS BLUE SHIELD
2807OTHERMADELTA DENTAL

General Provider Information

NPI Number : 1760413264
Entity Type Code : Organization
Provider Name (Legal Business Name) : DILLAWAY FAMILY DENTISTRY, P.C.
Provider Business Mailing Address
First Line : PO BOX 181
Second Line :
City : WESTON
State : MA
Zip : 02493-0001
Country : US
Telephone Number : 781-899-1181
Fax Number : 781-642-0609
Provider Business Practice Location Address
First Line : 30 COLPITTS RD
Second Line :
City : WESTON
State : MA
Zip : 02493-1534
Country : US
Telephone Number : 781-899-5084
Fax Number : 781-642-0609
Authorized Official
Title or Position : CLERK
Name : BARBARA A. DILLAWAY
Credential :
Telephone Number : 781-899-1181
Provider Enumeration Date : 07/05/2006
Last Update Date : 08/22/2020

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