Provider Demographics
NPI:1255388450
Name:HAVERHILL DENTAL ASSOCIATES INC
Entity type:Organization
Organization Name:HAVERHILL DENTAL ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:PALMER
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:JR
Authorized Official - Credentials:DMD
Authorized Official - Phone:978-372-8669
Mailing Address - Street 1:370 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HAVERHILL
Mailing Address - State:MA
Mailing Address - Zip Code:01830
Mailing Address - Country:US
Mailing Address - Phone:978-372-8669
Mailing Address - Fax:978-372-7474
Practice Address - Street 1:370 MAIN ST
Practice Address - Street 2:
Practice Address - City:HAVERHILL
Practice Address - State:MA
Practice Address - Zip Code:01830
Practice Address - Country:US
Practice Address - Phone:978-372-8669
Practice Address - Fax:978-372-7474
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
017399OtherUNITED CONCORDIA DENTAL P
5336415OtherAETNA DENTAL
MAX10186OtherBLUE CROSS BLUE SHIELD
MA40365OtherHARVARD PILGRIM HEALTHCAR
MA0294438Medicaid