Organization
HATHAWAY ROAD DENTAL, PC
Active
Other names
Cortland Dental
Organization subpart
No
Provider details
NPI number
Authorized official
MICHELLE JACOMINO (DIRECTOR OF PAYOR RELATIONS)
(770) 916-5036
Entity
Organization
Contact information
Practice address
1096 REVERE BEACH PKWY, CHELSEA, MA 02150
(617) 889-0177
(617) 889-0211
Mailing address
210 INTERSTATE NORTH PKWY SE STE 300, ATLANTA, GA 30339-2233
(770) 916-9000
(678) 247-7858
Taxonomy
Speciality
Code
Description
License number
State
1223E0200X
Endodontics
—
—
1223G0001X
General Practice Dentistry
Primary
—
—
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
—
—
Other
Enumeration date
10/06/2006
Last updated
07/20/2022
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