Provider Demographics
NPI:1265596225
Name:AFFILIATED FAMILY DENTAL CARE
Entity type:Organization
Organization Name:AFFILIATED FAMILY DENTAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:
Authorized Official - Last Name:DICICCO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-872-8806
Mailing Address - Street 1:116 COCHITUATE RD
Mailing Address - Street 2:
Mailing Address - City:FRAMINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01701-7978
Mailing Address - Country:US
Mailing Address - Phone:508-872-8896
Mailing Address - Fax:508-872-8810
Practice Address - Street 1:116 COCHITUATE RD
Practice Address - Street 2:
Practice Address - City:FRAMINGHAM
Practice Address - State:MA
Practice Address - Zip Code:01701-7978
Practice Address - Country:US
Practice Address - Phone:508-872-8896
Practice Address - Fax:508-872-8810
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-21
Last Update Date:2007-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA105781223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAX10843OtherBLUE CROSS IDENTIFIER