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Organization
WHITWORTH DENTAL ASSOC
Active
Organization
WHITWORTH DENTAL ASSOC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. E LEO WHITWORTH JR. DDS (PRES)
(617) 298-1955
Entity
Organization
Contact information
Practice address
542 RIVER ST, MATTAPAN, MA 02126-3014
(617) 298-1955
(617) 296-6004
Mailing address
542 RIVER ST, MATTAPAN, MA 02126-3014
(617) 298-1955
(617) 296-6004
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
9761829
—
MA
Enumeration date
05/23/2007
Last updated
08/22/2020
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