Organization
EUGENE A MICKEY, DMD, MPH, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. LISA A FIELD CDPMA (OFFICE MANAGER)
(781) 279-2400
Entity
Organization
Contact information
Practice address
67 MONTVALE AVE, SUITE 101, STONEHAM, MA 02180-3618
(781) 279-2400
(781) 279-4640
Mailing address
67 MONTVALE AVE, SUITE 101, STONEHAM, MA 02180-3618
(781) 279-2400
(781) 279-4640
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
14275
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
38861
HPHC
MA
01
—
659373
UNITED CONCORDIA
PA
01
—
X10967
BCBSMA
MA
Enumeration date
10/25/2006
Last updated
08/22/2020
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