Provider Demographics
NPI:1518091180
Name:COGNATA J DMD, MICHAEL&BARONE
Entity Type:Organization
Organization Name:COGNATA J DMD, MICHAEL&BARONE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE ASSISTANT
Authorized Official - Prefix:MS
Authorized Official - First Name:TERRA
Authorized Official - Middle Name:R
Authorized Official - Last Name:BAXTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-639-4500
Mailing Address - Street 1:210 HUMPHREY ST
Mailing Address - Street 2:SUITE 106
Mailing Address - City:MARBLEHEAD
Mailing Address - State:MA
Mailing Address - Zip Code:01945-1665
Mailing Address - Country:US
Mailing Address - Phone:781-639-4500
Mailing Address - Fax:781-639-9181
Practice Address - Street 1:210 HUMPHREY ST
Practice Address - Street 2:SUITE 106
Practice Address - City:MARBLEHEAD
Practice Address - State:MA
Practice Address - Zip Code:01945-1665
Practice Address - Country:US
Practice Address - Phone:781-639-4500
Practice Address - Fax:781-639-9181
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA169481223P0221X
MA139261223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
Not Answered1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA=========OtherTAX ID