Provider Demographics
NPI:1013022672
Name:METHEN DENTAL SPECIALTY ASSOC
Entity Type:Organization
Organization Name:METHEN DENTAL SPECIALTY ASSOC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLERK
Authorized Official - Prefix:DR
Authorized Official - First Name:HOWARD
Authorized Official - Middle Name:W
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:978-685-2471
Mailing Address - Street 1:60 EAST STREET SUITE 3200
Mailing Address - Street 2:
Mailing Address - City:METHVEN
Mailing Address - State:MA
Mailing Address - Zip Code:01844
Mailing Address - Country:US
Mailing Address - Phone:978-685-2471
Mailing Address - Fax:978-683-3985
Practice Address - Street 1:60 EAST STREETSUITE 3200
Practice Address - Street 2:
Practice Address - City:METHVEN
Practice Address - State:MA
Practice Address - Zip Code:01844
Practice Address - Country:US
Practice Address - Phone:978-685-2471
Practice Address - Fax:978-683-3985
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA185331223E0200X
MA204691223P0300X
MA161141223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty
Not Answered1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty
Not Answered1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty