Provider Demographics
NPI:1356460471
Name:R.A.SHORT & R.A. SCHNELL D.M.D.
Entity Type:Organization
Organization Name:R.A.SHORT & R.A. SCHNELL D.M.D.
Other - Org Name:THE CLASSIC SMILE
Other - Org Type:Other Name
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:A
Authorized Official - Last Name:SHORT
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:781-396-4131
Mailing Address - Street 1:92 HIGH ST
Mailing Address - Street 2:SUITE 12
Mailing Address - City:MEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02155-3850
Mailing Address - Country:US
Mailing Address - Phone:761-396-4131
Mailing Address - Fax:781-396-2064
Practice Address - Street 1:92 HIGH ST
Practice Address - Street 2:SUITE 12
Practice Address - City:MEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02155-3850
Practice Address - Country:US
Practice Address - Phone:761-396-4131
Practice Address - Fax:781-396-2064
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA151451223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty