Provider Demographics
NPI:1922013572
Name:DUXBURY CHILDRENS DENTISTRY LLC
Entity Type:Organization
Organization Name:DUXBURY CHILDRENS DENTISTRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOY
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:JOHN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:781-934-7111
Mailing Address - Street 1:95 TREMONT STREET
Mailing Address - Street 2:SUITE 18
Mailing Address - City:DUXBURY
Mailing Address - State:MA
Mailing Address - Zip Code:02332
Mailing Address - Country:US
Mailing Address - Phone:781-934-7111
Mailing Address - Fax:781-934-7125
Practice Address - Street 1:95 TREMONT STREET
Practice Address - Street 2:SUITE 18
Practice Address - City:DUXBURY
Practice Address - State:MA
Practice Address - Zip Code:02332
Practice Address - Country:US
Practice Address - Phone:781-934-7111
Practice Address - Fax:781-934-7125
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2014-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA204951223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty