Individual
PHILIP WADSWORTH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
6 ISLAND HILL AVE APT 412, MALDEN, MA 02148-2651
(570) 561-4759
Mailing address
100 RIVERS EDGE DR UNIT 326, MEDFORD, MA 02155-5471
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DN1856641
MA
390200000X
Student in an Organized Health Care Education/Training Program
DN1856641
MA
Other
Enumeration date
05/28/2014
Last updated
07/09/2015
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