Provider Demographics
NPI:1164668190
Name:DENTCARE DENTAL CENTER, LLP
Entity Type:Organization
Organization Name:DENTCARE DENTAL CENTER, LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ROSALYN
Authorized Official - Middle Name:H
Authorized Official - Last Name:DO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:978-777-5660
Mailing Address - Street 1:130 SYLVAN ST
Mailing Address - Street 2:
Mailing Address - City:DANVERS
Mailing Address - State:MA
Mailing Address - Zip Code:01923-3675
Mailing Address - Country:US
Mailing Address - Phone:978-777-5660
Mailing Address - Fax:
Practice Address - Street 1:130 SYLVAN ST
Practice Address - Street 2:
Practice Address - City:DANVERS
Practice Address - State:MA
Practice Address - Zip Code:01923-3675
Practice Address - Country:US
Practice Address - Phone:978-777-5660
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-22
Last Update Date:2008-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA17543122300000X
MA10000122300000X
MA21321122300000X
MA110641223E0200X
MA89101223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
No1223E0200XDental ProvidersDentistEndodonticsGroup - Multi-Specialty
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty