Provider Demographics
NPI:1598186645
Name:SOUTHCOAST COMMUNITY DENTAL CARE
Entity Type:Organization
Organization Name:SOUTHCOAST COMMUNITY DENTAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:LEITE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:774-451-2067
Mailing Address - Street 1:603 NEW BEDFORD RD
Mailing Address - Street 2:PO BOX 22
Mailing Address - City:ROCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:02770-4125
Mailing Address - Country:US
Mailing Address - Phone:774-451-2067
Mailing Address - Fax:
Practice Address - Street 1:603 NEW BEDFORD RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MA
Practice Address - Zip Code:02770-4125
Practice Address - Country:US
Practice Address - Phone:774-451-2067
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-16
Last Update Date:2013-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADH13264261QD0000X
MADH14025261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental