MEDICARE: TOWNSEND DENTAL GROUP, LLC

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	122300000X	Dentist

General Provider Information

NPI Number	:	1821437021
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TOWNSEND DENTAL GROUP, LLC

Provider Business Mailing Address
First Line	:	370 MAIN ST
Second Line	:	SUITE 101
City	:	WEST TOWNSEND
State	:	MA
Zip	:	01474-1052
Country	:	US
Telephone Number	:	978-597-2100
Fax Number	:

Provider Business Practice Location Address
First Line	:	370 MAIN ST
Second Line	:	SUITE 101
City	:	WEST TOWNSEND
State	:	MA
Zip	:	01474-1052
Country	:	US
Telephone Number	:	978-597-2100
Fax Number	:

Authorized Official
Title or Position	:	MEMBER
Name	:	DR. ERIC GHEEWALLA
Credential	:	D.M.D.
Telephone Number	:	978-597-2100

Provider Enumeration Date	:	06/20/2013
Last Update Date	:	06/20/2013

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