Provider Demographics
NPI:1801943394
Name:BRAINTREE PEDIATRIC DENTAL ASSOCIATES, LLC
Entity type:Organization
Organization Name:BRAINTREE PEDIATRIC DENTAL ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLENE
Authorized Official - Middle Name:
Authorized Official - Last Name:PIRNER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:781-356-4544
Mailing Address - Street 1:400 WASHINGTON ST
Mailing Address - Street 2:#301
Mailing Address - City:BRAINTREE
Mailing Address - State:MA
Mailing Address - Zip Code:02184-4729
Mailing Address - Country:US
Mailing Address - Phone:781-356-4544
Mailing Address - Fax:781-356-5375
Practice Address - Street 1:400 WASHINGTON ST
Practice Address - Street 2:#301
Practice Address - City:BRAINTREE
Practice Address - State:MA
Practice Address - Zip Code:02184-4729
Practice Address - Country:US
Practice Address - Phone:781-356-4544
Practice Address - Fax:781-356-5375
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA187291223P0221X
MA188431223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty