Provider Demographics
NPI:1285969600
Name:EASTON DENTAL PC
Entity type:Organization
Organization Name:EASTON DENTAL PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:TABBAH
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:617-851-3778
Mailing Address - Street 1:74 CONCERTO CT
Mailing Address - Street 2:
Mailing Address - City:NORTH EASTON
Mailing Address - State:MA
Mailing Address - Zip Code:02356-2762
Mailing Address - Country:US
Mailing Address - Phone:617-851-3778
Mailing Address - Fax:508-230-3733
Practice Address - Street 1:67 BELMONT ST
Practice Address - Street 2:
Practice Address - City:SOUTH EASTON
Practice Address - State:MA
Practice Address - Zip Code:02375-1103
Practice Address - Country:US
Practice Address - Phone:508-230-3737
Practice Address - Fax:508-230-3733
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-03
Last Update Date:2009-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAMA20277122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty