Provider Demographics
NPI:1053402081
Name:METROWEST FAMILY DENTAL
Entity type:Organization
Organization Name:METROWEST FAMILY DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIES
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:508-655-5331
Mailing Address - Street 1:220 N MAIN ST
Mailing Address - Street 2:SUITE 203
Mailing Address - City:NATICK
Mailing Address - State:MA
Mailing Address - Zip Code:01760-1100
Mailing Address - Country:US
Mailing Address - Phone:508-655-5331
Mailing Address - Fax:508-655-5449
Practice Address - Street 1:220 N MAIN ST
Practice Address - Street 2:SUITE 203
Practice Address - City:NATICK
Practice Address - State:MA
Practice Address - Zip Code:01760-1100
Practice Address - Country:US
Practice Address - Phone:508-655-5331
Practice Address - Fax:508-655-5449
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA19335122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty