Provider Demographics
NPI:1306012380
Name:OCEANSIDE DENTAL ASSOCIATES, P.C.
Entity Type:Organization
Organization Name:OCEANSIDE DENTAL ASSOCIATES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:SUSAN
Authorized Official - Last Name:EISEN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:781-324-6997
Mailing Address - Street 1:440 HUMPHREY ST
Mailing Address - Street 2:
Mailing Address - City:SWAMPSCOTT
Mailing Address - State:MA
Mailing Address - Zip Code:01907-2574
Mailing Address - Country:US
Mailing Address - Phone:781-324-6997
Mailing Address - Fax:
Practice Address - Street 1:440 HUMPHREY ST.
Practice Address - Street 2:
Practice Address - City:SWAMPSCOTT
Practice Address - State:MA
Practice Address - Zip Code:01907-2574
Practice Address - Country:US
Practice Address - Phone:781-324-6997
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-30
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA173671223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty