Provider Demographics
NPI:1215016043
Name:CAPE COD ENDODONTICS PC
Entity Type:Organization
Organization Name:CAPE COD ENDODONTICS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE CO OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:FRANCIS
Authorized Official - Last Name:BUCKLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:508-888-8482
Mailing Address - Street 1:110 LONG POND ROAD
Mailing Address - Street 2:SUITE 124
Mailing Address - City:PLYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02360
Mailing Address - Country:US
Mailing Address - Phone:508-747-4441
Mailing Address - Fax:508-746-3558
Practice Address - Street 1:110 LONG POND ROAD
Practice Address - Street 2:SUITE 124
Practice Address - City:PLYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02360
Practice Address - Country:US
Practice Address - Phone:508-747-4441
Practice Address - Fax:508-746-3558
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty