Provider Demographics
NPI:1750024378
Name:SIMPLY DENTAL AT WORCESTER, PLLC
Entity Type:Organization
Organization Name:SIMPLY DENTAL AT WORCESTER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:AIMEE
Authorized Official - Middle Name:
Authorized Official - Last Name:HODGERNEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-589-8270
Mailing Address - Street 1:87 ELM ST
Mailing Address - Street 2:
Mailing Address - City:HOPKINTON
Mailing Address - State:MA
Mailing Address - Zip Code:01748-1638
Mailing Address - Country:US
Mailing Address - Phone:508-589-8270
Mailing Address - Fax:
Practice Address - Street 1:255 PARK AVE STE 904
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01609-1978
Practice Address - Country:US
Practice Address - Phone:508-589-8270
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SIMPLY DENTAL AT WORCESTER, PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-04-20
Last Update Date:2022-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental