Provider Demographics
NPI:1912178831
Name:DOVER DENTAL ASSOCIARES PC
Entity Type:Organization
Organization Name:DOVER DENTAL ASSOCIARES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLERK
Authorized Official - Prefix:DR
Authorized Official - First Name:MAI
Authorized Official - Middle Name:
Authorized Official - Last Name:PHAN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:508-785-0356
Mailing Address - Street 1:30 SPRINGDALE AVE.
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:MA
Mailing Address - Zip Code:02030-0726
Mailing Address - Country:US
Mailing Address - Phone:508-078-5035
Mailing Address - Fax:508-785-0972
Practice Address - Street 1:30 SPRINGDALE AVE.
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:MA
Practice Address - Zip Code:02030-0726
Practice Address - Country:US
Practice Address - Phone:508-785-0356
Practice Address - Fax:508-785-0974
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-19
Last Update Date:2008-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA9140261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAX11362OtherBLUE CROSS BLUE SHIELD