Provider Demographics
NPI:1780912600
Name:GINSBERG FAMILY DENTAL LLC
Entity type:Organization
Organization Name:GINSBERG FAMILY DENTAL LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:GINSBERG
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:508-339-3766
Mailing Address - Street 1:235 CENTRAL ST
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:02048-1341
Mailing Address - Country:US
Mailing Address - Phone:508-339-3766
Mailing Address - Fax:508-339-3767
Practice Address - Street 1:235 CENTRAL ST
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:MA
Practice Address - Zip Code:02048-1341
Practice Address - Country:US
Practice Address - Phone:508-339-3766
Practice Address - Fax:508-339-3767
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-04
Last Update Date:2009-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA13591122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty