Provider Demographics
NPI:1831316207
Name:CENTER FOR AESTHETIC DENTISTRY
Entity Type:Organization
Organization Name:CENTER FOR AESTHETIC DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:F
Authorized Official - Last Name:LEIGH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:978-630-1702
Mailing Address - Street 1:380 ELM ST
Mailing Address - Street 2:
Mailing Address - City:GARDNER
Mailing Address - State:MA
Mailing Address - Zip Code:01440-3935
Mailing Address - Country:US
Mailing Address - Phone:978-630-1702
Mailing Address - Fax:978-630-2450
Practice Address - Street 1:380 ELM ST
Practice Address - Street 2:
Practice Address - City:GARDNER
Practice Address - State:MA
Practice Address - Zip Code:01440-3935
Practice Address - Country:US
Practice Address - Phone:978-630-1702
Practice Address - Fax:978-630-2450
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA20254122300000X
MA207571223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered122300000XDental ProvidersDentistGroup - Multi-Specialty
Not Answered1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty