Organization
COMMONWEALTH PERIODONTICS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN MARIE DEPATIE (DIRECTOR OF OPERATIONS)
(508) 754-1122
Entity
Organization
Contact information
Practice address
48 ELM ST, WORCESTER, MA 01609-2541
(150) 875-4122
(508) 754-9378
Mailing address
48 ELM ST, WORCESTER, MA 01609-2541
(150) 875-4122
(508) 754-9378
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
20952
MA
Other
Enumeration date
07/14/2014
Last updated
07/14/2014
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