Provider Demographics
NPI:1376977835
Name:DEANE DENTAL SOLUTIONS LLC
Entity Type:Organization
Organization Name:DEANE DENTAL SOLUTIONS LLC
Other - Org Name:DENTAL CENTER OF HARVARD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOY-ANN
Authorized Official - Middle Name:S
Authorized Official - Last Name:DEANE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:978-456-8737
Mailing Address - Street 1:40 MASSACHUSETTS AVE
Mailing Address - Street 2:
Mailing Address - City:HARVARD
Mailing Address - State:MA
Mailing Address - Zip Code:01451-1701
Mailing Address - Country:US
Mailing Address - Phone:978-456-8737
Mailing Address - Fax:
Practice Address - Street 1:40 MASSACHUSETTS AVE
Practice Address - Street 2:
Practice Address - City:HARVARD
Practice Address - State:MA
Practice Address - Zip Code:01451-1701
Practice Address - Country:US
Practice Address - Phone:978-456-8737
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-02
Last Update Date:2015-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA192161223G0001X
MA18556701223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty