Provider Demographics
NPI:1417048117
Name:CENTRAL DENTAL ASSOCIATES
Entity Type:Organization
Organization Name:CENTRAL DENTAL ASSOCIATES
Other - Org Name:S CORPORATION
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:L
Authorized Official - Last Name:VIVENTI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:781-769-3566
Mailing Address - Street 1:47 CENTRAL ST
Mailing Address - Street 2:
Mailing Address - City:NORWOOD
Mailing Address - State:MA
Mailing Address - Zip Code:02062
Mailing Address - Country:US
Mailing Address - Phone:781-769-3566
Mailing Address - Fax:781-769-0992
Practice Address - Street 1:47 CENTRAL ST
Practice Address - Street 2:
Practice Address - City:NORWOOD
Practice Address - State:MA
Practice Address - Zip Code:02062
Practice Address - Country:US
Practice Address - Phone:781-769-3566
Practice Address - Fax:781-769-0992
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA177181223E0200X
MA156451223G0001X
MA183501223G0001X
MA179641223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered1223E0200XDental ProvidersDentistEndodonticsGroup - Multi-Specialty
Not Answered1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Not Answered1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty