Provider Demographics
NPI:1780978353
Name:WHITINSVILLE FAMILY DENTISTRY, PC
Entity type:Organization
Organization Name:WHITINSVILLE FAMILY DENTISTRY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:R
Authorized Official - Last Name:TUBO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:508-234-8107
Mailing Address - Street 1:12 PROSPECT ST
Mailing Address - Street 2:
Mailing Address - City:WHITINSVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:01588-1458
Mailing Address - Country:US
Mailing Address - Phone:508-234-8107
Mailing Address - Fax:508-234-2913
Practice Address - Street 1:12 PROSPECT ST
Practice Address - Street 2:
Practice Address - City:WHITINSVILLE
Practice Address - State:MA
Practice Address - Zip Code:01588-1458
Practice Address - Country:US
Practice Address - Phone:508-234-8107
Practice Address - Fax:508-234-2913
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-01
Last Update Date:2011-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA22148122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty