Provider Demographics
NPI:1073853289
Name:COMMONWEALTH PEDIATRIC DENTAL
Entity type:Organization
Organization Name:COMMONWEALTH PEDIATRIC DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:MURPHY
Authorized Official - Suffix:JR
Authorized Official - Credentials:DMD
Authorized Official - Phone:508-884-4000
Mailing Address - Street 1:302 BROADWAY UNIT 1
Mailing Address - Street 2:
Mailing Address - City:RAYNHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02767-1439
Mailing Address - Country:US
Mailing Address - Phone:508-884-4000
Mailing Address - Fax:508-884-4003
Practice Address - Street 1:302 BROADWAY UNIT 1
Practice Address - Street 2:
Practice Address - City:RAYNHAM
Practice Address - State:MA
Practice Address - Zip Code:02767-1439
Practice Address - Country:US
Practice Address - Phone:508-884-4000
Practice Address - Fax:508-884-4003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-25
Last Update Date:2013-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN18552401223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty