Provider Demographics
NPI:1437394038
Name:CAPE PEDIATRIC DENTAL ASSOCIATES, PC
Entity Type:Organization
Organization Name:CAPE PEDIATRIC DENTAL ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MURRAY
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, MS
Authorized Official - Phone:508-432-7555
Mailing Address - Street 1:719 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:HARWICH CENTER
Mailing Address - State:MA
Mailing Address - Zip Code:02645-2751
Mailing Address - Country:US
Mailing Address - Phone:508-432-7555
Mailing Address - Fax:
Practice Address - Street 1:719 MAIN STREET
Practice Address - Street 2:
Practice Address - City:HARWICH CENTER
Practice Address - State:MA
Practice Address - Zip Code:02645-2751
Practice Address - Country:US
Practice Address - Phone:508-432-7555
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-10
Last Update Date:2008-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA152221223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty