Provider Demographics
NPI:1003263088
Name:COMMONWEALTH PEDIATRIC DENTAL PC
Entity Type:Organization
Organization Name:COMMONWEALTH PEDIATRIC DENTAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:MURPHY
Authorized Official - Suffix:JR
Authorized Official - Credentials:DMD
Authorized Official - Phone:508-884-4000
Mailing Address - Street 1:302 BROADWAY
Mailing Address - Street 2:SUITE 1
Mailing Address - City:RAYNHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02767-1439
Mailing Address - Country:US
Mailing Address - Phone:508-884-4000
Mailing Address - Fax:508-884-4003
Practice Address - Street 1:408 STATE RD
Practice Address - Street 2:SUITE 730
Practice Address - City:DARTMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02747-4302
Practice Address - Country:US
Practice Address - Phone:508-884-4000
Practice Address - Fax:508-884-4003
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COMMONWEALTH PEDIATRIC DENTAL PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-05-19
Last Update Date:2016-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty