Organization
FOR ALL AGES DENTAL ASSOCIATES
Active
Other names
For All Ages Dental Associates
Organization subpart
No
Provider details
NPI number
Authorized official
JENIEVE PAUL DMD (OWNER SOLE MBR)
(508) 586-1800
Entity
Organization
Contact information
Practice address
478 TORREY ST, SUITE 1, BROCKTON, MA 02301-4696
(508) 586-1800
Mailing address
478 TORREY ST, SUITE 1, BROCKTON, MA 02301
(508) 586-1800
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
20981
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
9902958
—
MA
Enumeration date
05/07/2015
Last updated
01/05/2016
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