Provider Demographics
NPI:1235187360
Name:NORFOLK COUNTY DENTAL ASSOCIATES, LLC
Entity Type:Organization
Organization Name:NORFOLK COUNTY DENTAL ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:IADAROLA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:508-528-6510
Mailing Address - Street 1:PO BOX 301
Mailing Address - Street 2:158 MAIN ST
Mailing Address - City:NORFOLK
Mailing Address - State:MA
Mailing Address - Zip Code:02056
Mailing Address - Country:US
Mailing Address - Phone:508-528-6510
Mailing Address - Fax:508-541-7937
Practice Address - Street 1:158 MAIN ST
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:MA
Practice Address - Zip Code:02056-1301
Practice Address - Country:US
Practice Address - Phone:508-528-6510
Practice Address - Fax:508-541-7937
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-04
Last Update Date:2013-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA149351223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty