Provider Demographics
NPI:1265973648
Name:SHIRLEY DENTAL CARE, INC
Entity type:Organization
Organization Name:SHIRLEY DENTAL CARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:R
Authorized Official - Last Name:ANNESE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:978-804-3641
Mailing Address - Street 1:228 GREAT RD
Mailing Address - Street 2:
Mailing Address - City:SHIRLEY
Mailing Address - State:MA
Mailing Address - Zip Code:01464-2216
Mailing Address - Country:US
Mailing Address - Phone:978-425-9088
Mailing Address - Fax:978-425-4503
Practice Address - Street 1:228 GREAT RD
Practice Address - Street 2:
Practice Address - City:SHIRLEY
Practice Address - State:MA
Practice Address - Zip Code:01464-2216
Practice Address - Country:US
Practice Address - Phone:978-425-9088
Practice Address - Fax:978-425-4503
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-17
Last Update Date:2017-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN1856006122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty