Provider Demographics
NPI:1962422782
Name:DENTISTRY FOR CHILDREN PC
Entity type:Organization
Organization Name:DENTISTRY FOR CHILDREN PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ELI
Authorized Official - Middle Name:C
Authorized Official - Last Name:SCHNEIDER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:781-331-0140
Mailing Address - Street 1:851 MAIN ST
Mailing Address - Street 2:#3
Mailing Address - City:SO WEYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02190-1613
Mailing Address - Country:US
Mailing Address - Phone:781-331-0140
Mailing Address - Fax:781-337-4700
Practice Address - Street 1:851 MAIN ST
Practice Address - Street 2:#3 NEVIN PROFESSIONAL BUILDING
Practice Address - City:SO WEYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02190-1613
Practice Address - Country:US
Practice Address - Phone:781-331-0140
Practice Address - Fax:781-337-4700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
Not Answered1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
M12122OtherBCBS MA