Organization
COMMONWEALTH MOBILE ORAL HEALTH SERVICES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARK J DOHERTY DMD,MPH,CCHP (DIRECTOR)
(508) 947-0111
Entity
Organization
Contact information
Practice address
12 COLLEEN DR, LAKEVILLE, MA 02347-1663
(508) 947-0111
(508) 743-7827
Mailing address
12 COLLEEN DR, LAKEVILLE, MA 02347-1663
(508) 947-0111
(508) 743-7827
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
12683
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01730905
—
NY
05
—
01761953
—
NY
05
—
0245844
—
MA
05
—
30010445
—
NH
05
—
30010446
—
NH
05
—
9756892
—
MA
Enumeration date
01/22/2007
Last updated
07/19/2012
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