Provider Demographics
NPI:1932739950
Name:ATTLEBORO PEDIATRIC DENTISTRY PLLC
Entity Type:Organization
Organization Name:ATTLEBORO PEDIATRIC DENTISTRY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FINANCIAL MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:VICKI
Authorized Official - Middle Name:
Authorized Official - Last Name:DEMERITT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-222-2510
Mailing Address - Street 1:550 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ATTLEBORO
Mailing Address - State:MA
Mailing Address - Zip Code:02703-1735
Mailing Address - Country:US
Mailing Address - Phone:508-222-2510
Mailing Address - Fax:508-222-3903
Practice Address - Street 1:550 N MAIN ST
Practice Address - Street 2:
Practice Address - City:ATTLEBORO
Practice Address - State:MA
Practice Address - Zip Code:02703-1735
Practice Address - Country:US
Practice Address - Phone:508-222-2510
Practice Address - Fax:508-222-3903
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-17
Last Update Date:2020-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty