Provider Demographics
NPI:1114114360
Name:CHILDRENS DENTAL HEALTH CENTER
Entity Type:Organization
Organization Name:CHILDRENS DENTAL HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:HERSCHLAG
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:781-341-0030
Mailing Address - Street 1:966 PARK ST # C
Mailing Address - Street 2:
Mailing Address - City:STOUGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02072-3650
Mailing Address - Country:US
Mailing Address - Phone:781-341-0030
Mailing Address - Fax:781-341-1166
Practice Address - Street 1:966 PARK ST # C
Practice Address - Street 2:
Practice Address - City:STOUGHTON
Practice Address - State:MA
Practice Address - Zip Code:02072-3650
Practice Address - Country:US
Practice Address - Phone:781-341-0030
Practice Address - Fax:781-341-1166
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-02
Last Update Date:2007-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA168041223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty