Provider Demographics
NPI:1528477320
Name:VISITINGDENTAL ASSOCIATES OF MA LLC
Entity type:Organization
Organization Name:VISITINGDENTAL ASSOCIATES OF MA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CATHY
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:GRINHAM
Authorized Official - Suffix:
Authorized Official - Credentials:RDH
Authorized Official - Phone:888-236-3536
Mailing Address - Street 1:18 PURCHASE ST
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBORO
Mailing Address - State:MA
Mailing Address - Zip Code:02346-3356
Mailing Address - Country:US
Mailing Address - Phone:888-236-3536
Mailing Address - Fax:
Practice Address - Street 1:18 PURCHASE ST
Practice Address - Street 2:
Practice Address - City:MIDDLEBORO
Practice Address - State:MA
Practice Address - Zip Code:02346-3356
Practice Address - Country:US
Practice Address - Phone:888-236-3536
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-05
Last Update Date:2014-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA127681223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223D0001XDental ProvidersDentistDental Public HealthGroup - Single Specialty