Provider Demographics
NPI:1265585657
Name:UPITE, EDMAR N (DDS)
Entity type:Individual
Prefix:DR
First Name:EDMAR
Middle Name:N
Last Name:UPITE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:380 MERRIMACK ST
Mailing Address - Street 2:SUITE #3E
Mailing Address - City:METHUEN
Mailing Address - State:MA
Mailing Address - Zip Code:01844-5870
Mailing Address - Country:US
Mailing Address - Phone:978-685-2511
Mailing Address - Fax:978-683-3985
Practice Address - Street 1:380 MERRIMACK ST
Practice Address - Street 2:SUITE #3E
Practice Address - City:METHUEN
Practice Address - State:MA
Practice Address - Zip Code:01844-5870
Practice Address - Country:US
Practice Address - Phone:978-685-2511
Practice Address - Fax:978-683-3985
Is Sole Proprietor?:No
Enumeration Date:2007-01-19
Last Update Date:2012-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA197031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0200671Medicaid