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Organization

AQUA DENTAL LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
JEFFREY FAYERMAN (OWNER)
(781) 963-6077
Entity
Organization

Contact information

Practice address
1395 N MAIN ST, RANDOLPH, MA 02368-1768
(781) 963-6077
Mailing address
1395 N MAIN ST, RANDOLPH, MA 02368-1768
(781) 963-6077

Taxonomy

Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
18450
MA

Other

Enumeration date
10/31/2008
Last updated
10/31/2008
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