Provider Demographics
NPI:1346613551
Name:EAST MILTON DENTAL LLC
Entity Type:Organization
Organization Name:EAST MILTON DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER/MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:TERESA
Authorized Official - Last Name:SWEENEY REGAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:617-698-3636
Mailing Address - Street 1:539 ADAMS ST
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:MA
Mailing Address - Zip Code:02186-5621
Mailing Address - Country:US
Mailing Address - Phone:617-698-3636
Mailing Address - Fax:
Practice Address - Street 1:539 ADAMS ST
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:MA
Practice Address - Zip Code:02186-5621
Practice Address - Country:US
Practice Address - Phone:617-698-3636
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-10
Last Update Date:2015-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN1855941122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty