Organization
SOUTHBRIDGE PLACE DENTAL, P.C.
Active
Other names
Cortland Dental Group
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DALE MAYFIELD (PRESIDENT)
(770) 916-5036
Entity
Organization
Contact information
Practice address
544 SOUTHBRIDGE ST, WORCESTER, MA 01610-1716
(774) 243-8592
Mailing address
1090 NORTHCHASE PKWY SE STE 290, MARIETTA, GA 30067-6402
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
1223P0106X
Oral and Maxillofacial Pathology Dentistry
—
—
1223P0221X
Pediatric Dentistry
—
—
1223P0300X
Periodontics
—
—
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
—
—
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
—
—
Other
Enumeration date
11/05/2018
Last updated
11/05/2018
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