Provider Demographics
NPI:1669566519
Name:SOUTH SHORE PERIODONTICS LLP
Entity type:Organization
Organization Name:SOUTH SHORE PERIODONTICS LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:T
Authorized Official - Last Name:UBERTALLI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:781-749-9444
Mailing Address - Street 1:175 DERBY STREET
Mailing Address - Street 2:SUITE #11
Mailing Address - City:HINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02043
Mailing Address - Country:US
Mailing Address - Phone:781-749-9444
Mailing Address - Fax:781-749-4487
Practice Address - Street 1:175 DERBY STREET
Practice Address - Street 2:SUITE #11
Practice Address - City:HINGHAM
Practice Address - State:MA
Practice Address - Zip Code:02043
Practice Address - Country:US
Practice Address - Phone:781-749-9444
Practice Address - Fax:781-749-4487
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA196451223P0300X
MA181431223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty