Provider Demographics
NPI:1295327476
Name:COHASSET DENTAL GROUP LLC
Entity type:Organization
Organization Name:COHASSET DENTAL GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HR DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KERSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:MARRAMA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-562-3442
Mailing Address - Street 1:500 CHAPMAN ST
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MA
Mailing Address - Zip Code:02021-2093
Mailing Address - Country:US
Mailing Address - Phone:781-562-3442
Mailing Address - Fax:
Practice Address - Street 1:12 PARKINGWAY
Practice Address - Street 2:
Practice Address - City:COHASSET
Practice Address - State:MA
Practice Address - Zip Code:02025-1708
Practice Address - Country:US
Practice Address - Phone:781-562-3442
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-09
Last Update Date:2021-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty