Provider Demographics
NPI:1053465369
Name:DENTAL ASSOCIATES OF WAKEFIELD, INC
Entity Type:Organization
Organization Name:DENTAL ASSOCIATES OF WAKEFIELD, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:N
Authorized Official - Last Name:BOSCIA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:401-789-9718
Mailing Address - Street 1:26 S COUNTY COMMONS WAY
Mailing Address - Street 2:UNIT 2
Mailing Address - City:WAKEFIELD
Mailing Address - State:RI
Mailing Address - Zip Code:02879-8239
Mailing Address - Country:US
Mailing Address - Phone:401-789-9718
Mailing Address - Fax:401-789-2525
Practice Address - Street 1:26 S COUNTY COMMONS WAY
Practice Address - Street 2:UNIT 2
Practice Address - City:WAKEFIELD
Practice Address - State:RI
Practice Address - Zip Code:02879-8239
Practice Address - Country:US
Practice Address - Phone:401-789-9718
Practice Address - Fax:401-789-2525
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI025741223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty