Provider Demographics
NPI:1962990820
Name:HYANNIS DENTAL GROUP PROFESSIONAL
Entity type:Organization
Organization Name:HYANNIS DENTAL GROUP PROFESSIONAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JANET
Authorized Official - Middle Name:
Authorized Official - Last Name:NEFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:774-470-2876
Mailing Address - Street 1:17 SCHOOL ST
Mailing Address - Street 2:
Mailing Address - City:HYANNIS
Mailing Address - State:MA
Mailing Address - Zip Code:02601-3117
Mailing Address - Country:US
Mailing Address - Phone:774-470-2876
Mailing Address - Fax:774-470-6191
Practice Address - Street 1:17 SCHOOL ST
Practice Address - Street 2:
Practice Address - City:HYANNIS
Practice Address - State:MA
Practice Address - Zip Code:02601-3117
Practice Address - Country:US
Practice Address - Phone:774-470-2876
Practice Address - Fax:774-470-6191
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-26
Last Update Date:2018-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110008422AMedicaid