Provider Demographics
NPI:1265973135
Name:YORK DENTAL GROUP LLC
Entity type:Organization
Organization Name:YORK DENTAL GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:T
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:781-562-0457
Mailing Address - Street 1:500 CHAPMAN ST UNIT 201
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MA
Mailing Address - Zip Code:02021-2040
Mailing Address - Country:US
Mailing Address - Phone:781-562-0457
Mailing Address - Fax:
Practice Address - Street 1:435 YORK ST
Practice Address - Street 2:
Practice Address - City:YORK HARBOR
Practice Address - State:ME
Practice Address - Zip Code:03911
Practice Address - Country:US
Practice Address - Phone:207-363-2166
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-13
Last Update Date:2017-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEDEN45231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty