Provider Demographics
NPI:1760459705
Name:PEDIATRIC DENTISTRY & ORTHODONTICS OF THE NORTH SHORE, LLC
Entity Type:Organization
Organization Name:PEDIATRIC DENTISTRY & ORTHODONTICS OF THE NORTH SHORE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:P
Authorized Official - Last Name:SENZAMICI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:978-777-3744
Mailing Address - Street 1:6 STATE RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:DANVERS
Mailing Address - State:MA
Mailing Address - Zip Code:01923-2567
Mailing Address - Country:US
Mailing Address - Phone:978-777-3744
Mailing Address - Fax:978-777-1544
Practice Address - Street 1:6 STATE RD
Practice Address - Street 2:SUITE 101
Practice Address - City:DANVERS
Practice Address - State:MA
Practice Address - Zip Code:01923-2567
Practice Address - Country:US
Practice Address - Phone:978-777-3744
Practice Address - Fax:978-777-1544
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA128611223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty