Provider Demographics
NPI:1639426315
Name:NORTH SHORE DENTAL CENTER
Entity Type:Organization
Organization Name:NORTH SHORE DENTAL CENTER
Other - Org Name:HIAM ELIAS, DMD, PC
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:ELIAS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:978-532-0088
Mailing Address - Street 1:6 ESSEX CENTER DR
Mailing Address - Street 2:STE. 302
Mailing Address - City:PEABODY
Mailing Address - State:MA
Mailing Address - Zip Code:01960-2904
Mailing Address - Country:US
Mailing Address - Phone:978-532-0088
Mailing Address - Fax:978-532-0089
Practice Address - Street 1:6 ESSEX CENTER DR
Practice Address - Street 2:STE. 302
Practice Address - City:PEABODY
Practice Address - State:MA
Practice Address - Zip Code:01960-2904
Practice Address - Country:US
Practice Address - Phone:978-532-0088
Practice Address - Fax:978-532-0089
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-13
Last Update Date:2012-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA18553311223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1245481456OtherINDIVIDUAL NPI