Provider Demographics
NPI:1285284604
Name:ADVANTAGE DENTAL ORAL HEALTH CENTER OF MASSACHUSETTS, PC
Entity type:Organization
Organization Name:ADVANTAGE DENTAL ORAL HEALTH CENTER OF MASSACHUSETTS, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SR. LICENSING & CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:JENELL
Authorized Official - Middle Name:
Authorized Official - Last Name:STUMP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-487-2916
Mailing Address - Street 1:2400 COMPUTER DR
Mailing Address - Street 2:
Mailing Address - City:WESTBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01581-1887
Mailing Address - Country:US
Mailing Address - Phone:508-329-2250
Mailing Address - Fax:
Practice Address - Street 1:2400 COMPUTER DR
Practice Address - Street 2:
Practice Address - City:WESTBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01581-1887
Practice Address - Country:US
Practice Address - Phone:508-329-2250
Practice Address - Fax:508-329-2255
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-17
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty