Provider Demographics
NPI:1073536462
Name:AFFORDABLE FAMILY DENTAL
Entity Type:Organization
Organization Name:AFFORDABLE FAMILY DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:MASSE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:617-889-2668
Mailing Address - Street 1:59 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:CHELSEA
Mailing Address - State:MA
Mailing Address - Zip Code:02150
Mailing Address - Country:US
Mailing Address - Phone:617-889-2668
Mailing Address - Fax:617-889-4819
Practice Address - Street 1:59 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:CHELSEA
Practice Address - State:MA
Practice Address - Zip Code:02150
Practice Address - Country:US
Practice Address - Phone:617-889-2668
Practice Address - Fax:617-889-4819
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9777431Medicaid