Provider Demographics
NPI:1871636225
Name:HOUSE OF SHOES OF DARTMOUTH INC.
Entity Type:Organization
Organization Name:HOUSE OF SHOES OF DARTMOUTH INC.
Other - Org Name:DARTMOUTH PEDORTHICS AT HARVE'S SHOE BOX
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:FRIEDLAND
Authorized Official - Suffix:
Authorized Official - Credentials:CERTIFIED PEDORTHIST
Authorized Official - Phone:508-997-7215
Mailing Address - Street 1:98 STATE RD
Mailing Address - Street 2:
Mailing Address - City:NORTH DARTMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02747-2921
Mailing Address - Country:US
Mailing Address - Phone:508-997-7215
Mailing Address - Fax:508-999-0236
Practice Address - Street 1:98 STATE RD
Practice Address - Street 2:
Practice Address - City:NORTH DARTMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02747-2921
Practice Address - Country:US
Practice Address - Phone:508-997-7215
Practice Address - Fax:508-999-0236
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1538861Medicaid
MA1069120001Medicare ID - Type Unspecified