Provider Demographics
NPI:1528571304
Name:DR DENTAL OF WOLCOTT PC
Entity Type:Organization
Organization Name:DR DENTAL OF WOLCOTT PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACCOUNTS PAYABLE
Authorized Official - Prefix:
Authorized Official - First Name:SHEILA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAMPAGNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-620-4563
Mailing Address - Street 1:945 CONCORD ST STE 231
Mailing Address - Street 2:
Mailing Address - City:FRAMINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01701-4613
Mailing Address - Country:US
Mailing Address - Phone:508-620-4563
Mailing Address - Fax:
Practice Address - Street 1:939 WOLCOTT ST UNIT 5B
Practice Address - Street 2:
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06705-1301
Practice Address - Country:US
Practice Address - Phone:508-620-4563
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-15
Last Update Date:2017-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental