1780048157 NPI number — GREAT MEADOWS DENTAL GROUP, P.C.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780048157 NPI number — GREAT MEADOWS DENTAL GROUP, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GREAT MEADOWS DENTAL GROUP, 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:
Provider Other Organization Name Type Code:
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:
1780048157
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/11/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
95 CAMPION RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORTH ANDOVER
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01845-1231
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
978-886-2678
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
56 GREAT RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BEDFORD
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01730-2120
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
978-886-2678
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/11/2016

Additional Information

Authorized Official

Authorized Official Last Name:
PAPAPETROS
Authorized Official First Name:
NICHOLAS
Authorized Official Middle Name:
THEODORE
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
978-886-2678

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  18093 , 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)





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