Provider Demographics
NPI:1669960027
Name:NEW ENGLAND FAMILY DENTISTRY ,PC
Entity type:Organization
Organization Name:NEW ENGLAND FAMILY DENTISTRY ,PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:J
Authorized Official - Last Name:CHOINIERE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-460-0632
Mailing Address - Street 1:5 MOUNT ROYAL AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:MARLBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01752-1900
Mailing Address - Country:US
Mailing Address - Phone:508-460-0632
Mailing Address - Fax:
Practice Address - Street 1:366 COOLEY ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01128-1144
Practice Address - Country:US
Practice Address - Phone:413-796-1616
Practice Address - Fax:413-796-1617
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NEW ENGLAND FAMILY DENTISTRY ,PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-05-01
Last Update Date:2018-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA18571911223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty