| Organization Name: | DR. DENTAL OF METHUEN, PC |
| NPI Number: | 1083907406 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | CHRIS INCOLLINGO (MANAGER) |
| Mailing Address: | 162 Haverhill St Methuen |
| State: | MA US |
| Postal Code: | 018443462 |
| Phone Number: | 6178872100 |
| Fax Number: | 6178872102 |
| NPI Enumeration Date: | 05/18/2011 |
| NPI Last Update Date: | 05/18/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QD0000X |
| License Number: | 20485 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MA |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Dental |
| Taxonomy Definition: | |