Provider Demographics
NPI:1265242341
Name:PEDIATRIC DENTAL ASSOCIATES OF NORWOOD
Entity type:Organization
Organization Name:PEDIATRIC DENTAL ASSOCIATES OF NORWOOD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PEDIATRIC DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:V
Authorized Official - Last Name:DANBERG-FICARELLI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:917-575-5280
Mailing Address - Street 1:9 W BROADWAY UNIT 112
Mailing Address - Street 2:
Mailing Address - City:SOUTH BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02127-1041
Mailing Address - Country:US
Mailing Address - Phone:917-575-5280
Mailing Address - Fax:
Practice Address - Street 1:111 LENOX ST STE 113
Practice Address - Street 2:
Practice Address - City:NORWOOD
Practice Address - State:MA
Practice Address - Zip Code:02062-4278
Practice Address - Country:US
Practice Address - Phone:781-769-4473
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-10
Last Update Date:2025-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty