Provider Demographics
NPI:1003366790
Name:ADVANCED DENTAL CARE
Entity Type:Organization
Organization Name:ADVANCED DENTAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:MCGONIGLE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:781-272-2875
Mailing Address - Street 1:388 CAMBRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01803-1945
Mailing Address - Country:US
Mailing Address - Phone:781-272-2875
Mailing Address - Fax:
Practice Address - Street 1:388 CAMBRIDGE ST
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:MA
Practice Address - Zip Code:01803-1945
Practice Address - Country:US
Practice Address - Phone:781-272-2875
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-06
Last Update Date:2016-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN20865122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty