Provider Demographics
NPI:1811504830
Name:ESSEX DENTAL LLC
Entity type:Organization
Organization Name:ESSEX DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:KONEFAL
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:413-695-8612
Mailing Address - Street 1:26 ANDREW ST APT 2F
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:MA
Mailing Address - Zip Code:01970-4376
Mailing Address - Country:US
Mailing Address - Phone:413-695-8612
Mailing Address - Fax:
Practice Address - Street 1:9 PICKERING ST
Practice Address - Street 2:
Practice Address - City:ESSEX
Practice Address - State:MA
Practice Address - Zip Code:01929-1213
Practice Address - Country:US
Practice Address - Phone:978-768-6525
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-24
Last Update Date:2020-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty