Provider Demographics
NPI:1740682517
Name:CAPE COD PERIODONTICS PC
Entity type:Organization
Organization Name:CAPE COD PERIODONTICS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNDER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOE
Authorized Official - Middle Name:A
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:858-761-2404
Mailing Address - Street 1:244 WILLOW ST
Mailing Address - Street 2:
Mailing Address - City:YARMOUTH PORT
Mailing Address - State:MA
Mailing Address - Zip Code:02675-1757
Mailing Address - Country:US
Mailing Address - Phone:508-375-9090
Mailing Address - Fax:508-375-3323
Practice Address - Street 1:244 WILLOW ST
Practice Address - Street 2:
Practice Address - City:YARMOUTH PORT
Practice Address - State:MA
Practice Address - Zip Code:02675-1757
Practice Address - Country:US
Practice Address - Phone:508-375-9090
Practice Address - Fax:508-375-3323
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-23
Last Update Date:2016-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN18559231223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty