Provider Demographics
NPI:1568609014
Name:DR. ROLAND G. NENTWICH
Entity Type:Organization
Organization Name:DR. ROLAND G. NENTWICH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ROLAND
Authorized Official - Middle Name:GERALD
Authorized Official - Last Name:NENTWICH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:508-845-6711
Mailing Address - Street 1:506 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:SHREWSBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01545
Mailing Address - Country:US
Mailing Address - Phone:508-845-6711
Mailing Address - Fax:508-842-0648
Practice Address - Street 1:506 MAIN STREET
Practice Address - Street 2:
Practice Address - City:SHREWSBURY
Practice Address - State:MA
Practice Address - Zip Code:01545
Practice Address - Country:US
Practice Address - Phone:508-845-6711
Practice Address - Fax:508-842-0648
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-20
Last Update Date:2009-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA126281223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1366469355OtherPERSONAL IDENTIFITICATION NUMBER