Provider Demographics
NPI:1902836786
Name:TEWKSBURY DENTAL ASSOCIATES
Entity Type:Organization
Organization Name:TEWKSBURY DENTAL ASSOCIATES
Other - Org Name:DRS. COOPER, SPILLER AND NAHATA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:R
Authorized Official - Last Name:SPILLER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:978-851-7890
Mailing Address - Street 1:1418 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:TEWKSBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01876-2046
Mailing Address - Country:US
Mailing Address - Phone:978-851-7890
Mailing Address - Fax:978-851-7734
Practice Address - Street 1:1418 MAIN ST
Practice Address - Street 2:
Practice Address - City:TEWKSBURY
Practice Address - State:MA
Practice Address - Zip Code:01876-2046
Practice Address - Country:US
Practice Address - Phone:978-851-7890
Practice Address - Fax:978-851-7734
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-04
Last Update Date:2013-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty