Provider Demographics
NPI:1972768364
Name:ALPHA DENTAL CENTER, PC
Entity Type:Organization
Organization Name:ALPHA DENTAL CENTER, PC
Other - Org Name:POCASSET FAMILY DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MUNAL
Authorized Official - Middle Name:
Authorized Official - Last Name:SALEM
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:508-563-2722
Mailing Address - Street 1:676 MACARTHUR BLVD
Mailing Address - Street 2:
Mailing Address - City:POCASSET
Mailing Address - State:MA
Mailing Address - Zip Code:02559-2230
Mailing Address - Country:US
Mailing Address - Phone:508-563-2722
Mailing Address - Fax:508-563-6020
Practice Address - Street 1:676 MACARTHUR BLVD
Practice Address - Street 2:
Practice Address - City:POCASSET
Practice Address - State:MA
Practice Address - Zip Code:02559-2230
Practice Address - Country:US
Practice Address - Phone:508-563-2722
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ALPHA DENTAL CENTER, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-07-24
Last Update Date:2013-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA147651223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty