Organization
MILLIS DENTAL CARE, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RENEE GRAVELINE (CREDENTIALING SPECIALIST)
(774) 241-6254
Entity
Organization
Contact information
Practice address
MILLIS DENTAL CARE, PC, 840 MAIN STREET, SUITE 112, MILLIS, MA 02054-1542
(508) 556-0882
(508) 376-8997
Mailing address
28 MAPLEWOOD AVE, SUDBURY, MA 01776-1534
(617) 999-7686
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DN1856691
MA
Other
Enumeration date
05/09/2018
Last updated
05/09/2018
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