Provider Demographics
NPI:1326380205
Name:DENTAQUEST MID-ATLANTIC, INC.
Entity Type:Organization
Organization Name:DENTAQUEST MID-ATLANTIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:HAWKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-886-1511
Mailing Address - Street 1:465 MEDFORD ST
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02129-1426
Mailing Address - Country:US
Mailing Address - Phone:617-886-1818
Mailing Address - Fax:
Practice Address - Street 1:4061 POWDER MILL RD
Practice Address - Street 2:SUITE 325
Practice Address - City:CALVERTON
Practice Address - State:MD
Practice Address - Zip Code:20705-3149
Practice Address - Country:US
Practice Address - Phone:617-886-1818
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-19
Last Update Date:2013-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty