1760997670 NPI number — WESTBOROUGH DENTAL PARTNERS, P.C.

Table of content: (NPI 1760997670)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760997670 NPI number — WESTBOROUGH DENTAL PARTNERS, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WESTBOROUGH DENTAL PARTNERS, P.C.
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:
COMMONWEALTH DENTAL ASSOCIATES
Provider Other Organization Name Type Code:
3
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:
1760997670
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/23/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5 MOUNT ROYAL AVE STE 300
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MARLBOROUGH
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01752-1900
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-460-0632
Provider Business Mailing Address Fax Number:
508-872-0781

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
176 E MAIN ST STE 2
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WESTBOROUGH
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01581
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-366-8300
Provider Business Practice Location Address Fax Number:
508-870-1848
Provider Enumeration Date:
12/14/2017

Additional Information

Authorized Official

Authorized Official Last Name:
TAVANO
Authorized Official First Name:
JOANNE
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF OPERATING OFFICER
Authorized Official Telephone Number:
978-580-1524

Provider Taxonomy Codes

  • Taxonomy code: 122300000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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