Provider Demographics
NPI:1407681364
Name:EXCELLENCE DENTAL CARE PLLC
Entity type:Organization
Organization Name:EXCELLENCE DENTAL CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:EVIS
Authorized Official - Middle Name:
Authorized Official - Last Name:MYFTIU
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:857-559-3507
Mailing Address - Street 1:1116 GREAT PLAIN AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:NEEDHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02492-2344
Mailing Address - Country:US
Mailing Address - Phone:857-540-8367
Mailing Address - Fax:
Practice Address - Street 1:1116 GREAT PLAIN AVE STE 102
Practice Address - Street 2:
Practice Address - City:NEEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02492-2344
Practice Address - Country:US
Practice Address - Phone:857-540-8367
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-02
Last Update Date:2024-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental