Provider Demographics
NPI:1437282357
Name:SOUTH SHORE DENTAL PROSTHETIC ASSOCIATES, INC.
Entity Type:Organization
Organization Name:SOUTH SHORE DENTAL PROSTHETIC ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:KARL
Authorized Official - Last Name:TROSSELLO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD,MSCD
Authorized Official - Phone:617-471-1890
Mailing Address - Street 1:165 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169-5514
Mailing Address - Country:US
Mailing Address - Phone:617-471-1890
Mailing Address - Fax:617-471-7310
Practice Address - Street 1:165 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169-5514
Practice Address - Country:US
Practice Address - Phone:617-471-1890
Practice Address - Fax:617-471-7310
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA123141223G0001X, 1223P0700X, 1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Not Answered1223P0700XDental ProvidersDentistProsthodonticsGroup - Multi-Specialty
Not Answered1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty