MEDICARE: SUBURBAN ENDODONTIC ASSOC. D.B.A. ABINGTON FAMILY DENTAL CARE INC.

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	1223E0200X	Endodontics	14400	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	14400	OTHER	MA	MASS LICENSE #

General Provider Information

NPI Number	:	1831365816
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUBURBAN ENDODONTIC ASSOC. D.B.A. ABINGTON FAMILY DENTAL CARE INC.

Provider Business Mailing Address
First Line	:	PO BOX 2049
Second Line	:	469 WASHINGTON ST.
City	:	ABINGTON
State	:	MA
Zip	:	02351-0549
Country	:	US
Telephone Number	:	781-878-2190
Fax Number	:	781-878-3011

Provider Business Practice Location Address
First Line	:	469 WASHINGTON ST
Second Line	:
City	:	ABINGTON
State	:	MA
Zip	:	02351-2417
Country	:	US
Telephone Number	:	781-878-2190
Fax Number	:	781-878-3011

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MRS. BETTE LYNDE
Credential	:
Telephone Number	:	781-878-2190

Provider Enumeration Date	:	04/30/2008
Last Update Date	:	04/30/2008

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