Provider Demographics
NPI:1215051867
Name:HYANNIS DENTAL ASSOCIATES,LLC
Entity type:Organization
Organization Name:HYANNIS DENTAL ASSOCIATES,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JACK
Authorized Official - Middle Name:STEVEN
Authorized Official - Last Name:MASSARSKY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:508-778-4488
Mailing Address - Street 1:750 ATTUCKS LN
Mailing Address - Street 2:
Mailing Address - City:HYANNIS
Mailing Address - State:MA
Mailing Address - Zip Code:02601-1950
Mailing Address - Country:US
Mailing Address - Phone:508-778-4488
Mailing Address - Fax:508-778-2266
Practice Address - Street 1:750 ATTUCKS LN
Practice Address - Street 2:
Practice Address - City:HYANNIS
Practice Address - State:MA
Practice Address - Zip Code:02601-1950
Practice Address - Country:US
Practice Address - Phone:508-778-4488
Practice Address - Fax:508-778-2266
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2014-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA15233501223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty