Provider Demographics
NPI:1588219794
Name:EVERETT WORKWELL DENTAL PLLC
Entity type:Organization
Organization Name:EVERETT WORKWELL DENTAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DISTRICT MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:GIAIMO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-291-2773
Mailing Address - Street 1:1 MILITIA DR STE 203
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02421-4703
Mailing Address - Country:US
Mailing Address - Phone:781-862-5958
Mailing Address - Fax:
Practice Address - Street 1:826 BROADWAY
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:MA
Practice Address - Zip Code:02149-3027
Practice Address - Country:US
Practice Address - Phone:617-389-0877
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-05
Last Update Date:2019-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental