Organization
SHIELD PEDIATRIC DENTISTRY INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DANIEL GONZALEZ DMD (OWNER)
(617) 548-6717
Entity
Organization
Contact information
Practice address
683 STATE RD, WESTPORT, MA 02790-2848
(617) 548-6717
Mailing address
683 STATE RD, WESTPORT, MA 02790-2848
(617) 548-6717
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
—
—
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
—
—
261QD0000X
Dental Clinic/Center
—
—
Other
Enumeration date
11/28/2018
Last updated
11/28/2018
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