Provider Demographics
NPI:1437441508
Name:MEDFIELD DENTAL
Entity Type:Organization
Organization Name:MEDFIELD DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARI
Authorized Official - Middle Name:
Authorized Official - Last Name:BAE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:508-359-6900
Mailing Address - Street 1:36 JANES AVE
Mailing Address - Street 2:
Mailing Address - City:MEDFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:02052-2005
Mailing Address - Country:US
Mailing Address - Phone:508-359-6900
Mailing Address - Fax:508-359-7900
Practice Address - Street 1:36 JANES AVE
Practice Address - Street 2:
Practice Address - City:MEDFIELD
Practice Address - State:MA
Practice Address - Zip Code:02052-2005
Practice Address - Country:US
Practice Address - Phone:508-359-6900
Practice Address - Fax:508-359-7900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-09
Last Update Date:2011-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA22201261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental