Provider Demographics
NPI:1225554371
Name:VISITING DENTAL XRAYS PC
Entity Type:Organization
Organization Name:VISITING DENTAL XRAYS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:GRINHAM
Authorized Official - Suffix:
Authorized Official - Credentials:RDH
Authorized Official - Phone:508-813-6034
Mailing Address - Street 1:15 SLAB BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:ASSONET
Mailing Address - State:MA
Mailing Address - Zip Code:02702-1434
Mailing Address - Country:US
Mailing Address - Phone:508-813-6034
Mailing Address - Fax:
Practice Address - Street 1:15 SLAB BRIDGE RD
Practice Address - Street 2:
Practice Address - City:ASSONET
Practice Address - State:MA
Practice Address - Zip Code:02702-1434
Practice Address - Country:US
Practice Address - Phone:508-813-6034
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335V00000XSuppliersPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9903769Medicaid