Provider Demographics
NPI:1700182649
Name:JANE MCNULTY
Entity Type:Organization
Organization Name:JANE MCNULTY
Other - Org Name:AMITY DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTAL HYGIENIST
Authorized Official - Prefix:
Authorized Official - First Name:JANE
Authorized Official - Middle Name:KATHERINE
Authorized Official - Last Name:MCNULTY
Authorized Official - Suffix:
Authorized Official - Credentials:RN, RDH
Authorized Official - Phone:508-687-9752
Mailing Address - Street 1:PO BOX 4477
Mailing Address - Street 2:
Mailing Address - City:VINEYARD HAVEN
Mailing Address - State:MA
Mailing Address - Zip Code:02568-0935
Mailing Address - Country:US
Mailing Address - Phone:508-687-9752
Mailing Address - Fax:
Practice Address - Street 1:65 MAIN ST
Practice Address - Street 2:UNIT 2
Practice Address - City:VINEYARD HAVEN
Practice Address - State:MA
Practice Address - Zip Code:02568-0935
Practice Address - Country:US
Practice Address - Phone:508-687-9752
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-09
Last Update Date:2011-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADH9566124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes124Q00000XDental ProvidersDental HygienistGroup - Multi-Specialty