Organization
CITY DENTAL LLC
Active
Parent organization
CITY DENTAL LLC
Organization subpart
Yes
Provider details
NPI number
Legal business name
CITY DENTAL LLC
Authorized official
CIELITO DE AYALA (OFFICE MANAGER)
(401) 942-5051
Entity
Organization
Contact information
Practice address
439 BROADWAY, EVERETT, MA 02149-3612
(617) 944-9627
(617) 944-9742
Mailing address
439 BROADWAY, EVERETT, MA 02149-3612
(617) 944-9627
(617) 944-9742
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DN8735
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1548321235
—
MA
Enumeration date
12/29/2011
Last updated
12/29/2011
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