Provider Demographics
NPI:1740906759
Name:STONEHAM DENTAL CARE, PLLC
Entity type:Organization
Organization Name:STONEHAM DENTAL CARE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:A
Authorized Official - Last Name:PETRELLI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:617-605-1200
Mailing Address - Street 1:112 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:STONEHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02180-1605
Mailing Address - Country:US
Mailing Address - Phone:781-438-1995
Mailing Address - Fax:
Practice Address - Street 1:112 MAIN ST
Practice Address - Street 2:
Practice Address - City:STONEHAM
Practice Address - State:MA
Practice Address - Zip Code:02180-1605
Practice Address - Country:US
Practice Address - Phone:781-438-1995
Practice Address - Fax:781-438-6378
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-12
Last Update Date:2022-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty