Provider Demographics
NPI:1255882312
Name:CANCADO DIGITAL DENTAL CENTER, PC
Entity type:Organization
Organization Name:CANCADO DIGITAL DENTAL CENTER, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIA ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:CANCADO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:781-539-6900
Mailing Address - Street 1:ZERO GOVERNORS AVE 20-21
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02155
Mailing Address - Country:US
Mailing Address - Phone:781-539-6900
Mailing Address - Fax:
Practice Address - Street 1:ZERO GOVERNORS AVE
Practice Address - Street 2:20-21
Practice Address - City:MEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02155
Practice Address - Country:US
Practice Address - Phone:781-539-6900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-24
Last Update Date:2016-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA205881223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty