Provider Demographics
NPI:1225260276
Name:CHILDRENS DENTAL ASSOCIATES (WESTFORD)
Entity Type:Organization
Organization Name:CHILDRENS DENTAL ASSOCIATES (WESTFORD)
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:A
Authorized Official - Last Name:FRANK
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:781-391-8300
Mailing Address - Street 1:175 LITTLETON RD
Mailing Address - Street 2:
Mailing Address - City:WESTFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01886-3196
Mailing Address - Country:US
Mailing Address - Phone:978-392-9800
Mailing Address - Fax:
Practice Address - Street 1:175 LITTLETON RD
Practice Address - Street 2:
Practice Address - City:WESTFORD
Practice Address - State:MA
Practice Address - Zip Code:01886-3196
Practice Address - Country:US
Practice Address - Phone:978-392-9800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHILDRENS DENTAL ASSOCIATES (MEDFORD)
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-08-10
Last Update Date:2009-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA108081223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty