Provider Demographics
NPI:1669097150
Name:VISITING DENTAL ASSOCIATES OF MA INC
Entity type:Organization
Organization Name:VISITING DENTAL ASSOCIATES OF MA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CATHY
Authorized Official - Middle Name:J
Authorized Official - Last Name:GRINHAM
Authorized Official - Suffix:
Authorized Official - Credentials:RDH
Authorized Official - Phone:888-236-3536
Mailing Address - Street 1:15 SLAB BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:ASSONET
Mailing Address - State:MA
Mailing Address - Zip Code:02702-1434
Mailing Address - Country:US
Mailing Address - Phone:508-813-6034
Mailing Address - Fax:
Practice Address - Street 1:15 SLAB BRIDGE RD
Practice Address - Street 2:
Practice Address - City:ASSONET
Practice Address - State:MA
Practice Address - Zip Code:02702-1434
Practice Address - Country:US
Practice Address - Phone:508-813-6034
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-10
Last Update Date:2020-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare