Provider Demographics
NPI:1396120689
Name:LENNON STREET DENTAL ASSOCIATES PLLC
Entity type:Organization
Organization Name:LENNON STREET DENTAL ASSOCIATES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:HARVEY
Authorized Official - Middle Name:
Authorized Official - Last Name:APOTHEKER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:978-632-5502
Mailing Address - Street 1:39 LENNON ST
Mailing Address - Street 2:
Mailing Address - City:GARDNER
Mailing Address - State:MA
Mailing Address - Zip Code:01440-3907
Mailing Address - Country:US
Mailing Address - Phone:978-632-5502
Mailing Address - Fax:978-632-0964
Practice Address - Street 1:39 LENNON ST
Practice Address - Street 2:
Practice Address - City:GARDNER
Practice Address - State:MA
Practice Address - Zip Code:01440-3907
Practice Address - Country:US
Practice Address - Phone:978-632-5502
Practice Address - Fax:978-632-0964
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-28
Last Update Date:2015-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA13152122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty