Provider Demographics
NPI:1043771793
Name:DEMI ATHANS DMD LLC
Entity Type:Organization
Organization Name:DEMI ATHANS DMD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DEMI
Authorized Official - Middle Name:
Authorized Official - Last Name:ATHANS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:508-804-3131
Mailing Address - Street 1:916 SOUTHBRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:MA
Mailing Address - Zip Code:01501-1321
Mailing Address - Country:US
Mailing Address - Phone:508-804-3131
Mailing Address - Fax:
Practice Address - Street 1:916 SOUTHBRIDGE ST
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:MA
Practice Address - Zip Code:01501-1321
Practice Address - Country:US
Practice Address - Phone:774-262-2570
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-26
Last Update Date:2019-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty