Provider Demographics
NPI:1972140390
Name:BELMONT FAMILY DENTAL CENTER OF BROCKTON
Entity Type:Organization
Organization Name:BELMONT FAMILY DENTAL CENTER OF BROCKTON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ALISON
Authorized Official - Middle Name:M
Authorized Official - Last Name:HUBBARD
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:508-586-2668
Mailing Address - Street 1:185 BELMONT ST
Mailing Address - Street 2:
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02301-5159
Mailing Address - Country:US
Mailing Address - Phone:508-586-2668
Mailing Address - Fax:
Practice Address - Street 1:185 BELMONT ST
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-5159
Practice Address - Country:US
Practice Address - Phone:508-586-2668
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-04
Last Update Date:2019-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty