Provider Demographics
NPI:1003272006
Name:PEDIATRIC DENTAL CENTER OF MANSFIELD
Entity Type:Organization
Organization Name:PEDIATRIC DENTAL CENTER OF MANSFIELD
Other - Org Name:PEDIATRIC DENTAL CENTER-BRIDGEWATER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:MOREAU
Authorized Official - Suffix:SR
Authorized Official - Credentials:DMD
Authorized Official - Phone:508-337-3307
Mailing Address - Street 1:1029 PLEASANT ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:BRIDGEWATER
Mailing Address - State:MA
Mailing Address - Zip Code:02324-2301
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1029 PLEASANT ST
Practice Address - Street 2:SUITE 103
Practice Address - City:BRIDGEWATER
Practice Address - State:MA
Practice Address - Zip Code:02324-2301
Practice Address - Country:US
Practice Address - Phone:508-337-3307
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-06
Last Update Date:2016-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty