Provider Demographics
NPI:1134772114
Name:ALPHA DENTAL CENTER OF TAUNTON, LLC
Entity type:Organization
Organization Name:ALPHA DENTAL CENTER OF TAUNTON, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MARDY
Authorized Official - Middle Name:
Authorized Official - Last Name:COSTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-822-2582
Mailing Address - Street 1:247 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:TAUNTON
Mailing Address - State:MA
Mailing Address - Zip Code:02780-1508
Mailing Address - Country:US
Mailing Address - Phone:508-822-2582
Mailing Address - Fax:508-880-9434
Practice Address - Street 1:247 BROADWAY
Practice Address - Street 2:
Practice Address - City:TAUNTON
Practice Address - State:MA
Practice Address - Zip Code:02780-1508
Practice Address - Country:US
Practice Address - Phone:508-822-2582
Practice Address - Fax:508-880-9434
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-19
Last Update Date:2019-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty