Provider Demographics
NPI:1588839195
Name:NORTH SHORE CENTER FOR COSMETIC DENTISTRY, INC
Entity Type:Organization
Organization Name:NORTH SHORE CENTER FOR COSMETIC DENTISTRY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:T
Authorized Official - Last Name:PLOTKA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:781-599-8300
Mailing Address - Street 1:293 HUMPHREY ST
Mailing Address - Street 2:
Mailing Address - City:SWAMPSCOTT
Mailing Address - State:MA
Mailing Address - Zip Code:01907-2548
Mailing Address - Country:US
Mailing Address - Phone:781-599-8300
Mailing Address - Fax:
Practice Address - Street 1:293 HUMPHREY ST
Practice Address - Street 2:
Practice Address - City:SWAMPSCOTT
Practice Address - State:MA
Practice Address - Zip Code:01907-2548
Practice Address - Country:US
Practice Address - Phone:781-599-8301
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-24
Last Update Date:2017-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA11381122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty