Provider Demographics
NPI:1255411831
Name:DENTAL ASSOCIATES OF WALPOLE
Entity type:Organization
Organization Name:DENTAL ASSOCIATES OF WALPOLE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:RUSSELL
Authorized Official - Last Name:PAGE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:508-668-8008
Mailing Address - Street 1:1428 MAIN ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:WALPOLE
Mailing Address - State:MA
Mailing Address - Zip Code:02081-1729
Mailing Address - Country:US
Mailing Address - Phone:508-668-8008
Mailing Address - Fax:508-668-8808
Practice Address - Street 1:1428 MAIN ST
Practice Address - Street 2:SUITE 1
Practice Address - City:WALPOLE
Practice Address - State:MA
Practice Address - Zip Code:02081-1729
Practice Address - Country:US
Practice Address - Phone:508-668-8008
Practice Address - Fax:508-668-8808
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2016-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA122461223P0221X
MA126071223X0400X
MA113771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty