Provider Demographics
NPI:1972797645
Name:DAVID W. PHOENIX, DMD PC
Entity Type:Organization
Organization Name:DAVID W. PHOENIX, DMD PC
Other - Org Name:BOXFORD & TOPSFIELD DENTAL CARE
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:WALTER
Authorized Official - Last Name:PHOENIX
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:978-887-6373
Mailing Address - Street 1:16 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:TOPSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01983-1813
Mailing Address - Country:US
Mailing Address - Phone:978-887-6373
Mailing Address - Fax:
Practice Address - Street 1:16 S MAIN ST
Practice Address - Street 2:
Practice Address - City:TOPSFIELD
Practice Address - State:MA
Practice Address - Zip Code:01983-1813
Practice Address - Country:US
Practice Address - Phone:978-887-6373
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-05
Last Update Date:2011-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA18819261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA70010000X08056OtherBLUE CROSS BLUE SHIELD OF MA