Provider Demographics
NPI:1215390208
Name:NORWELL FAMILY DENTISTRY LLC
Entity Type:Organization
Organization Name:NORWELL FAMILY DENTISTRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LIAT
Authorized Official - Middle Name:B
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:781-659-4034
Mailing Address - Street 1:334 WASHINGTON ST
Mailing Address - Street 2:2
Mailing Address - City:NORWELL
Mailing Address - State:MA
Mailing Address - Zip Code:02061-1756
Mailing Address - Country:US
Mailing Address - Phone:781-659-4034
Mailing Address - Fax:781-659-4080
Practice Address - Street 1:334 WASHINGTON ST
Practice Address - Street 2:2
Practice Address - City:NORWELL
Practice Address - State:MA
Practice Address - Zip Code:02061-1756
Practice Address - Country:US
Practice Address - Phone:781-659-4034
Practice Address - Fax:781-659-4080
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-29
Last Update Date:2016-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN19970305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization