Provider Demographics
NPI:1083680110
Name:MASHPEE DENTAL ASSOCIATES LLC
Entity Type:Organization
Organization Name:MASHPEE DENTAL ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CONSTANTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:DARZENTA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:508-477-0070
Mailing Address - Street 1:PO BOX 545
Mailing Address - Street 2:
Mailing Address - City:MASHPEE
Mailing Address - State:MA
Mailing Address - Zip Code:02649-0545
Mailing Address - Country:US
Mailing Address - Phone:508-477-0070
Mailing Address - Fax:508-539-0870
Practice Address - Street 1:96 OLD BARNSTABLE RD
Practice Address - Street 2:
Practice Address - City:MASHPEE
Practice Address - State:MA
Practice Address - Zip Code:02649-3232
Practice Address - Country:US
Practice Address - Phone:508-477-0070
Practice Address - Fax:508-539-0870
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA151601223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty