Provider Demographics
NPI:1669809646
Name:WELLNESS DENTAL, L.L.C.
Entity type:Organization
Organization Name:WELLNESS DENTAL, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:ROSS
Authorized Official - Last Name:VIRGADAMO
Authorized Official - Suffix:SR
Authorized Official - Credentials:DMD
Authorized Official - Phone:1508-943-2300
Mailing Address - Street 1:PO BOX 868
Mailing Address - Street 2:96 WORCESTER RD.
Mailing Address - City:WEBSTER
Mailing Address - State:MA
Mailing Address - Zip Code:01570
Mailing Address - Country:US
Mailing Address - Phone:508-943-2300
Mailing Address - Fax:508-949-3981
Practice Address - Street 1:96 WORCESTER RD.
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:MA
Practice Address - Zip Code:01570
Practice Address - Country:US
Practice Address - Phone:508-943-2300
Practice Address - Fax:508-949-3981
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-04
Last Update Date:2013-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA119881223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty