Provider Demographics
NPI:1003188095
Name:DENTAL CENTER PEDIATRICS PC
Entity Type:Organization
Organization Name:DENTAL CENTER PEDIATRICS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:
Authorized Official - Last Name:KRITSINELI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:508-830-1212
Mailing Address - Street 1:45 RESNIK RD
Mailing Address - Street 2:SUITE 306
Mailing Address - City:PLYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02360-4844
Mailing Address - Country:US
Mailing Address - Phone:508-830-1212
Mailing Address - Fax:
Practice Address - Street 1:45 RESNIK RD
Practice Address - Street 2:SUITE 306
Practice Address - City:PLYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02360-4844
Practice Address - Country:US
Practice Address - Phone:508-830-1212
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-06
Last Update Date:2012-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN1855121261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental