Provider Demographics
NPI:1215380407
Name:SONGBIRD DENTAL PC
Entity Type:Organization
Organization Name:SONGBIRD DENTAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LUCIANA
Authorized Official - Middle Name:C
Authorized Official - Last Name:PETTO MESSINA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:508-842-8100
Mailing Address - Street 1:555 MAIN ST
Mailing Address - Street 2:ST 1-3
Mailing Address - City:SHREWSBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01545-2932
Mailing Address - Country:US
Mailing Address - Phone:508-612-7952
Mailing Address - Fax:508-842-4282
Practice Address - Street 1:555 MAIN ST
Practice Address - Street 2:ST 1-3
Practice Address - City:SHREWSBURY
Practice Address - State:MA
Practice Address - Zip Code:01545-2932
Practice Address - Country:US
Practice Address - Phone:508-612-7952
Practice Address - Fax:508-842-4282
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-22
Last Update Date:2016-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN1855142122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1477780856OtherMEDICARE PART D