Provider Demographics
NPI:1578788303
Name:EAST GROVE FAMILY DENTAL INC.
Entity Type:Organization
Organization Name:EAST GROVE FAMILY DENTAL INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:BARTEK
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:508-947-4770
Mailing Address - Street 1:70 E GROVE ST
Mailing Address - Street 2:P.O. BOX 656
Mailing Address - City:MIDDLEBORO
Mailing Address - State:MA
Mailing Address - Zip Code:02346-1810
Mailing Address - Country:US
Mailing Address - Phone:508-947-4770
Mailing Address - Fax:508-946-0660
Practice Address - Street 1:70 E GROVE ST
Practice Address - Street 2:
Practice Address - City:MIDDLEBORO
Practice Address - State:MA
Practice Address - Zip Code:02346-1810
Practice Address - Country:US
Practice Address - Phone:508-947-4770
Practice Address - Fax:508-946-0660
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA207931223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty