1831416767 NPI number — DB PRACTICE MANAGEMENT, INC

Table of content: (NPI 1831416767)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831416767 NPI number — DB PRACTICE MANAGEMENT, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DB PRACTICE MANAGEMENT, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1831416767
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/03/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
488 ESSEX STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAWRENCE
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01840
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
978-975-8888
Provider Business Mailing Address Fax Number:
978-291-0097

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
488 ESSEX ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAWRENCE
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01840
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
978-975-8888
Provider Business Practice Location Address Fax Number:
978-291-0097
Provider Enumeration Date:
05/03/2010

Additional Information

Authorized Official

Authorized Official Last Name:
GONZALEZ
Authorized Official First Name:
DARIO
Authorized Official Middle Name:
Authorized Official Title or Position:
VICE PRESIDENT/PERIODONTIST
Authorized Official Telephone Number:
617-519-6199

Provider Taxonomy Codes

  • Taxonomy code: 1223P0300X , with the licence number:  DN22028 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1223G0001X , with the licence number: DN22028 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 221597 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com