Provider Demographics
NPI:1053890780
Name:NEWBURYPORT DENTAL GROUP LLC
Entity type:Organization
Organization Name:NEWBURYPORT DENTAL GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:TODD
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:781-562-0457
Mailing Address - Street 1:500 CHAPMAN ST UNIT 201
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MA
Mailing Address - Zip Code:02021-2040
Mailing Address - Country:US
Mailing Address - Phone:781-562-0457
Mailing Address - Fax:
Practice Address - Street 1:1 INN ST APT 4
Practice Address - Street 2:
Practice Address - City:NEWBURYPORT
Practice Address - State:MA
Practice Address - Zip Code:01950-2557
Practice Address - Country:US
Practice Address - Phone:978-462-2530
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-13
Last Update Date:2018-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty