Provider Demographics
NPI:1831365816
Name:SUBURBAN ENDODONTIC ASSOC. D.B.A. ABINGTON FAMILY DENTAL CARE INC.
Entity type:Organization
Organization Name:SUBURBAN ENDODONTIC ASSOC. D.B.A. ABINGTON FAMILY DENTAL CARE INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:LYNDE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-878-2190
Mailing Address - Street 1:PO BOX 2049
Mailing Address - Street 2:469 WASHINGTON ST.
Mailing Address - City:ABINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02351-0549
Mailing Address - Country:US
Mailing Address - Phone:781-878-2190
Mailing Address - Fax:781-878-3011
Practice Address - Street 1:469 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:ABINGTON
Practice Address - State:MA
Practice Address - Zip Code:02351-2417
Practice Address - Country:US
Practice Address - Phone:781-878-2190
Practice Address - Fax:781-878-3011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-30
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA144001223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA14400OtherMASS LICENSE #