Provider Demographics
NPI:1942358627
Name:EASTON PEDIATRIC DENTISTRY, LLC
Entity Type:Organization
Organization Name:EASTON PEDIATRIC DENTISTRY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHARLENE
Authorized Official - Middle Name:
Authorized Official - Last Name:PIRNER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:508-238-0900
Mailing Address - Street 1:165 BELMONT ST
Mailing Address - Street 2:SUITE #B
Mailing Address - City:SOUTH EASTON
Mailing Address - State:MA
Mailing Address - Zip Code:02375-1901
Mailing Address - Country:US
Mailing Address - Phone:508-238-0900
Mailing Address - Fax:508-238-1988
Practice Address - Street 1:165 BELMONT ST
Practice Address - Street 2:SUITE #B
Practice Address - City:SOUTH EASTON
Practice Address - State:MA
Practice Address - Zip Code:02375-1901
Practice Address - Country:US
Practice Address - Phone:508-238-0900
Practice Address - Fax:508-238-1988
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA188431223P0221X
MA187291223P0221X
MA193841223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty