Provider Demographics
NPI:1447384078
Name:TOWN OF DEDHAM
Entity Type:Organization
Organization Name:TOWN OF DEDHAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PUBLIC HEALTH NURSE
Authorized Official - Prefix:
Authorized Official - First Name:CLARE
Authorized Official - Middle Name:A
Authorized Official - Last Name:GARDINER
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:781-751-9224
Mailing Address - Street 1:26 BRYANT ST
Mailing Address - Street 2:
Mailing Address - City:DEDHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02026-4458
Mailing Address - Country:US
Mailing Address - Phone:781-751-9224
Mailing Address - Fax:781-751-9229
Practice Address - Street 1:26 BRYANT ST
Practice Address - Street 2:
Practice Address - City:DEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02026-4458
Practice Address - Country:US
Practice Address - Phone:781-751-9224
Practice Address - Fax:781-751-9229
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2010-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY11068Medicare ID - Type Unspecified