Provider Demographics
NPI:1972839033
Name:DENTAL WELLNESS GROUP PC
Entity Type:Organization
Organization Name:DENTAL WELLNESS GROUP PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:DR
Authorized Official - First Name:RICAHRD
Authorized Official - Middle Name:M
Authorized Official - Last Name:PRICE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:781-826-3915
Mailing Address - Street 1:59 COLUMBIAN ST
Mailing Address - Street 2:
Mailing Address - City:WEYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02190-2414
Mailing Address - Country:US
Mailing Address - Phone:781-337-6644
Mailing Address - Fax:
Practice Address - Street 1:59 COLUMBIAN ST
Practice Address - Street 2:
Practice Address - City:WEYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02190-2414
Practice Address - Country:US
Practice Address - Phone:781-337-6644
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-26
Last Update Date:2009-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty