Provider Demographics
NPI:1316318686
Name:OUTER CAPE DENTAL GROUP, LLC
Entity type:Organization
Organization Name:OUTER CAPE DENTAL GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:F
Authorized Official - Last Name:TOOMEY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:508-349-6300
Mailing Address - Street 1:PO BOX 700
Mailing Address - Street 2:10 CANNON HILL RD
Mailing Address - City:SOUTH WELLFLEET
Mailing Address - State:MA
Mailing Address - Zip Code:02663-0700
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10 CANNON HILL RD
Practice Address - Street 2:
Practice Address - City:SOUTH WELLFLEET
Practice Address - State:MA
Practice Address - Zip Code:02663
Practice Address - Country:US
Practice Address - Phone:508-349-6300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-13
Last Update Date:2015-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN145061223P0700X
DN216251223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No1223P0700XDental ProvidersDentistProsthodonticsGroup - Multi-Specialty