Provider Demographics
NPI:1265824023
Name:OSTERVILLE FAMILY DENTAL
Entity Type:Organization
Organization Name:OSTERVILLE FAMILY DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TALIDA
Authorized Official - Middle Name:M
Authorized Official - Last Name:FLONTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-428-2443
Mailing Address - Street 1:21 POND ST
Mailing Address - Street 2:UNIT 4
Mailing Address - City:OSTERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02655-1508
Mailing Address - Country:US
Mailing Address - Phone:508-428-2443
Mailing Address - Fax:508-591-8560
Practice Address - Street 1:21 POND ST
Practice Address - Street 2:UNIT 4
Practice Address - City:OSTERVILLE
Practice Address - State:MA
Practice Address - Zip Code:02655-1508
Practice Address - Country:US
Practice Address - Phone:508-428-2443
Practice Address - Fax:508-591-8560
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-03
Last Update Date:2015-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA18554411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty