Provider Demographics
NPI:1366620437
Name:CENTRAL PLAZA FAMILY DENTAL
Entity type:Organization
Organization Name:CENTRAL PLAZA FAMILY DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:BRETT
Authorized Official - Middle Name:
Authorized Official - Last Name:SIGWORTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:978-452-3000
Mailing Address - Street 1:89 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:MA
Mailing Address - Zip Code:01852-2621
Mailing Address - Country:US
Mailing Address - Phone:978-452-3000
Mailing Address - Fax:978-452-3003
Practice Address - Street 1:89 CHURCH ST
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01852-2621
Practice Address - Country:US
Practice Address - Phone:978-452-3000
Practice Address - Fax:978-452-3003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-31
Last Update Date:2008-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA20485122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty