Provider Demographics
NPI:1275190423
Name:PEDIATRIC AND FAMILY DENTISTRY OF NORWOOD PLLC
Entity Type:Organization
Organization Name:PEDIATRIC AND FAMILY DENTISTRY OF NORWOOD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DMD/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DESPINA
Authorized Official - Middle Name:
Authorized Official - Last Name:LIAKOS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:617-953-8448
Mailing Address - Street 1:761 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:NORWOOD
Mailing Address - State:MA
Mailing Address - Zip Code:02062-6612
Mailing Address - Country:US
Mailing Address - Phone:781-762-7900
Mailing Address - Fax:
Practice Address - Street 1:761 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:NORWOOD
Practice Address - State:MA
Practice Address - Zip Code:02062-6612
Practice Address - Country:US
Practice Address - Phone:781-762-7900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-23
Last Update Date:2019-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty