Provider Demographics
NPI:1922566041
Name:ALLIANCE DENTAL CENTER, LLC
Entity Type:Organization
Organization Name:ALLIANCE DENTAL CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:FOURNIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-426-5878
Mailing Address - Street 1:PO BOX 4114
Mailing Address - Street 2:
Mailing Address - City:PEABODY
Mailing Address - State:MA
Mailing Address - Zip Code:01961-4114
Mailing Address - Country:US
Mailing Address - Phone:617-426-5878
Mailing Address - Fax:
Practice Address - Street 1:111 WASHINGTON ST STE 301
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169-5354
Practice Address - Country:US
Practice Address - Phone:617-984-5300
Practice Address - Fax:617-481-0905
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-07
Last Update Date:2021-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty