Provider Demographics
NPI:1376091280
Name:HINGHAM DENTAL GROUP LLC
Entity Type:Organization
Organization Name:HINGHAM DENTAL GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:781-749-1488
Mailing Address - Street 1:500 CHAPMAN ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:CANTON
Mailing Address - State:MA
Mailing Address - Zip Code:02021-2093
Mailing Address - Country:US
Mailing Address - Phone:781-749-1488
Mailing Address - Fax:
Practice Address - Street 1:118 SOUTH ST
Practice Address - Street 2:
Practice Address - City:HINGHAM
Practice Address - State:MA
Practice Address - Zip Code:02043-2440
Practice Address - Country:US
Practice Address - Phone:781-749-1488
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-20
Last Update Date:2017-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAMA20980122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty