Provider Demographics
NPI:1215795521
Name:DOVETAIL PAC RI
Entity type:Organization
Organization Name:DOVETAIL PAC RI
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:INDIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MICHEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-653-6951
Mailing Address - Street 1:345 NEPONSET ST STE 3
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MA
Mailing Address - Zip Code:02021-1988
Mailing Address - Country:US
Mailing Address - Phone:781-653-6951
Mailing Address - Fax:781-205-1543
Practice Address - Street 1:345 NEPONSET STREET SUITE 3
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MA
Practice Address - Zip Code:02021
Practice Address - Country:US
Practice Address - Phone:781-653-6951
Practice Address - Fax:781-205-1543
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-11
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty