Provider Demographics
NPI:1720188675
Name:SOUTH SHORE DENTISTRY
Entity Type:Organization
Organization Name:SOUTH SHORE DENTISTRY
Other - Org Name:LARRY D. BURT DMD PC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER-DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:BURT
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:781-331-3030
Mailing Address - Street 1:696 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:SOUTH WEYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02190
Mailing Address - Country:US
Mailing Address - Phone:781-331-3030
Mailing Address - Fax:781-335-5878
Practice Address - Street 1:696 MAIN STREET
Practice Address - Street 2:
Practice Address - City:SOUTH WEYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02190
Practice Address - Country:US
Practice Address - Phone:781-331-3030
Practice Address - Fax:781-335-5878
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
Last Update Date:2020-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA162571223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty