Provider Demographics
NPI:1982869947
Name:MARTHAS VINEYARD HOSPITAL DENTAL CENTER
Entity Type:Organization
Organization Name:MARTHAS VINEYARD HOSPITAL DENTAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:J
Authorized Official - Last Name:GANEM
Authorized Official - Suffix:
Authorized Official - Credentials:CFO
Authorized Official - Phone:508-684-4587
Mailing Address - Street 1:1 HOSPITAL ROAD
Mailing Address - Street 2:PO BOX 1477
Mailing Address - City:OAK BLUFFS
Mailing Address - State:MA
Mailing Address - Zip Code:02557-1477
Mailing Address - Country:US
Mailing Address - Phone:508-693-0410
Mailing Address - Fax:
Practice Address - Street 1:1 HOSPITAL ROAD
Practice Address - Street 2:
Practice Address - City:OAK BLUFFS
Practice Address - State:MA
Practice Address - Zip Code:02557
Practice Address - Country:US
Practice Address - Phone:508-693-0410
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MARTHAS VINEYARD HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-07-18
Last Update Date:2022-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental