Provider Demographics
NPI:1407263908
Name:WORCESTER HILLS DENTAL PC
Entity Type:Organization
Organization Name:WORCESTER HILLS DENTAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DMD, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MAREEN
Authorized Official - Middle Name:E
Authorized Official - Last Name:GEORGE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:508-798-9040
Mailing Address - Street 1:290 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01609-1805
Mailing Address - Country:US
Mailing Address - Phone:508-798-9040
Mailing Address - Fax:508-798-9060
Practice Address - Street 1:290 PARK AVE
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01609-1805
Practice Address - Country:US
Practice Address - Phone:508-798-9040
Practice Address - Fax:508-798-9060
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-16
Last Update Date:2014-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty