Organization
TATAKET DENTAL ASSOC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. E LEO WHITWORTH JR. DDS (PRES)
(508) 540-2448
Entity
Organization
Contact information
Practice address
6 TATAKET SQ, TEATICKET, MA 02536-5644
(508) 540-2448
(508) 548-2205
Mailing address
6 TATAKET SQ, TEATICKET, MA 02536-5644
(508) 540-2448
(508) 548-2205
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
9784004
—
MA
Enumeration date
05/23/2007
Last updated
08/22/2020
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