Provider Demographics
NPI:1174036925
Name:SUDBURY FAMILY DENTAL CARE
Entity Type:Organization
Organization Name:SUDBURY FAMILY DENTAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MAUREEN
Authorized Official - Middle Name:
Authorized Official - Last Name:CASALI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:978-443-5193
Mailing Address - Street 1:370 BOSTON POST RD
Mailing Address - Street 2:
Mailing Address - City:SUDBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01776-3049
Mailing Address - Country:US
Mailing Address - Phone:978-773-5193
Mailing Address - Fax:978-443-4063
Practice Address - Street 1:370 BOSTON POST RD
Practice Address - Street 2:
Practice Address - City:SUDBURY
Practice Address - State:MA
Practice Address - Zip Code:01776-3049
Practice Address - Country:US
Practice Address - Phone:978-443-5193
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty