Provider Demographics
NPI:1275805582
Name:DR DENTAL OF WATERTOWN PC
Entity Type:Organization
Organization Name:DR DENTAL OF WATERTOWN PC
Other - Org Name:DR DENTAL OF NEWTON PC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:DEXTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:603-232-2266
Mailing Address - Street 1:861 HANOVER ST
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03104-5419
Mailing Address - Country:US
Mailing Address - Phone:603-232-2266
Mailing Address - Fax:603-232-2278
Practice Address - Street 1:191 WATERTOWN ST
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:MA
Practice Address - Zip Code:02472-2571
Practice Address - Country:US
Practice Address - Phone:603-232-2266
Practice Address - Fax:603-232-2278
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-01
Last Update Date:2012-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty