Provider Demographics
NPI:1437690138
Name:MASSACHUSETTS DENTAL ARTS, P.C.
Entity Type:Organization
Organization Name:MASSACHUSETTS DENTAL ARTS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:BRZOZA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:718-513-9594
Mailing Address - Street 1:1 ROOSEVELT AVE
Mailing Address - Street 2:203
Mailing Address - City:PEABODY
Mailing Address - State:MA
Mailing Address - Zip Code:01960-2200
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1 ROOSEVELT AVE
Practice Address - Street 2:203
Practice Address - City:PEABODY
Practice Address - State:MA
Practice Address - Zip Code:01960-2200
Practice Address - Country:US
Practice Address - Phone:718-513-9594
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-14
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN1855670122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA=========OtherEIN