Provider Demographics
NPI:1972545481
Name:ATTLEBORO CUMBERLAND ORAL SURGEONS INC
Entity Type:Organization
Organization Name:ATTLEBORO CUMBERLAND ORAL SURGEONS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:F
Authorized Official - Last Name:BIERNACKI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:401-658-2224
Mailing Address - Street 1:3353 MENDON RD
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:RI
Mailing Address - Zip Code:02864
Mailing Address - Country:US
Mailing Address - Phone:401-658-2224
Mailing Address - Fax:401-658-0039
Practice Address - Street 1:3353 MENDON RD
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:RI
Practice Address - Zip Code:02864
Practice Address - Country:US
Practice Address - Phone:401-658-2224
Practice Address - Fax:401-658-0039
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-11
Last Update Date:2008-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI016141223S0112X
MA0121001223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
86509OtherRIBC
X10578OtherBCBS MA