Provider Demographics
NPI:1760599781
Name:DENTAL SPECIALTIES INC
Entity Type:Organization
Organization Name:DENTAL SPECIALTIES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELAINE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:FAIRFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:CDA
Authorized Official - Phone:781-963-2222
Mailing Address - Street 1:950 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:RANDOLPH
Mailing Address - State:MA
Mailing Address - Zip Code:02368-3064
Mailing Address - Country:US
Mailing Address - Phone:781-963-2222
Mailing Address - Fax:781-963-1282
Practice Address - Street 1:950 N MAIN ST
Practice Address - Street 2:
Practice Address - City:RANDOLPH
Practice Address - State:MA
Practice Address - Zip Code:02368-3064
Practice Address - Country:US
Practice Address - Phone:781-963-2222
Practice Address - Fax:781-963-1282
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-24
Last Update Date:2008-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA103771223G0001X
MA154881223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty