Provider Demographics
NPI:1639261894
Name:UNIVERSITY DENTAL GROUP PC
Entity Type:Organization
Organization Name:UNIVERSITY DENTAL GROUP PC
Other - Org Name:BUONOMO CANDELA MERCADANTE SAVAGE & URSOLEO PC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:BISCEGLIA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:508-753-1911
Mailing Address - Street 1:330 PLANTATION STREET
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01604
Mailing Address - Country:US
Mailing Address - Phone:508-753-1911
Mailing Address - Fax:508-753-1837
Practice Address - Street 1:330 PLANTATION STREET
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01604
Practice Address - Country:US
Practice Address - Phone:508-753-1911
Practice Address - Fax:508-753-1837
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA77236OtherDELTA DENTAL
MA00236OtherDELTA DENTAL
MAX10254OtherB CROSS BLUE SHIELD