Provider Demographics
NPI:1619522455
Name:SEABREEZE DENTAL CARE, LLC
Entity Type:Organization
Organization Name:SEABREEZE DENTAL CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MARDY
Authorized Official - Middle Name:
Authorized Official - Last Name:COSTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-728-5019
Mailing Address - Street 1:PO BOX 1734
Mailing Address - Street 2:
Mailing Address - City:MATTAPOISETT
Mailing Address - State:MA
Mailing Address - Zip Code:02739-0445
Mailing Address - Country:US
Mailing Address - Phone:508-758-4818
Mailing Address - Fax:508-758-1369
Practice Address - Street 1:28 FAIRHAVEN RD
Practice Address - Street 2:
Practice Address - City:MATTAPOISETT
Practice Address - State:MA
Practice Address - Zip Code:02739-1479
Practice Address - Country:US
Practice Address - Phone:508-758-4818
Practice Address - Fax:508-758-1369
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-08
Last Update Date:2019-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty