Provider Demographics
NPI:1033209135
Name:WORCESTER DENTAL ASSOCIATES PC
Entity Type:Organization
Organization Name:WORCESTER DENTAL ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:F
Authorized Official - Last Name:UNGER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:508-798-0627
Mailing Address - Street 1:86 PLEASANT ST
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01609-3204
Mailing Address - Country:US
Mailing Address - Phone:508-798-0627
Mailing Address - Fax:
Practice Address - Street 1:86 PLEASANT ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01609-3204
Practice Address - Country:US
Practice Address - Phone:508-798-0627
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-13
Last Update Date:2011-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA14281122300000X
MA20174122300000X
MA17989122300000X
MA14928122300000X
MA14588122300000X
MA21581122300000X, 1223X0400X
MA191421223P0300X
MA107471223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
No1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty