Provider Demographics
NPI:1083885248
Name:WOODS HOLE DENTAL CARE PC
Entity Type:Organization
Organization Name:WOODS HOLE DENTAL CARE PC
Other - Org Name:BRUCE R. LEGER
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:LEGER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:508-548-6655
Mailing Address - Street 1:91 A WATER STREET
Mailing Address - Street 2:P.O. BOX 125
Mailing Address - City:WOODS HOLE
Mailing Address - State:MA
Mailing Address - Zip Code:02543-0125
Mailing Address - Country:US
Mailing Address - Phone:508-548-6655
Mailing Address - Fax:508-548-1549
Practice Address - Street 1:91 A WATER STREET
Practice Address - Street 2:
Practice Address - City:WOODS HOLE
Practice Address - State:MA
Practice Address - Zip Code:02543-0125
Practice Address - Country:US
Practice Address - Phone:508-548-6655
Practice Address - Fax:508-548-1549
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-17
Last Update Date:2008-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0218545OtherMASS HEALTH
MA9903044OtherMASS HEALTH
MA9793836OtherMASS HEALTH
MA9902996OtherMASS HEALTH