Provider Demographics
NPI:1770947301
Name:CORNERSTONE DENTAL CARE, INC.
Entity type:Organization
Organization Name:CORNERSTONE DENTAL CARE, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TRACI
Authorized Official - Middle Name:ALLISON
Authorized Official - Last Name:PORTNOFF
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:508-366-3623
Mailing Address - Street 1:1300 UNION ST
Mailing Address - Street 2:#G-101
Mailing Address - City:WESTBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01581-5416
Mailing Address - Country:US
Mailing Address - Phone:508-366-3623
Mailing Address - Fax:508-616-0206
Practice Address - Street 1:1300 UNION ST
Practice Address - Street 2:#G-101
Practice Address - City:WESTBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01581-5416
Practice Address - Country:US
Practice Address - Phone:508-366-3623
Practice Address - Fax:508-616-0206
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-10
Last Update Date:2016-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA19517122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty