Provider Demographics
NPI:1811301971
Name:BAY STATE ENDODONTICS LLC
Entity type:Organization
Organization Name:BAY STATE ENDODONTICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:ARTHUR
Authorized Official - Last Name:FISHER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS MS
Authorized Official - Phone:508-850-7311
Mailing Address - Street 1:39 ACORN RD
Mailing Address - Street 2:
Mailing Address - City:NORTH EASTON
Mailing Address - State:MA
Mailing Address - Zip Code:02356-3624
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:555 PROVIDENCE HWY
Practice Address - Street 2:UNIT 1A
Practice Address - City:WALPOLE
Practice Address - State:MA
Practice Address - Zip Code:02081-4230
Practice Address - Country:US
Practice Address - Phone:508-850-7311
Practice Address - Fax:508-850-7988
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-17
Last Update Date:2014-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty