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Organization

SHAWSHEEN FAMILY DENTAL

Active
Organization subpart
No

Provider details

NPI number
Authorized official
CARLA BUSTILLO-GONZALEZ D.D.S. (OWNER)
(978) 851-7112
Entity
Organization

Contact information

Practice address
1455 MAIN ST, TEWKSBURY, MA 01876-4769
(978) 851-7112
(978) 851-2811
Mailing address
1455 MAIN ST, TEWKSBURY, MA 01876-4769
(978) 851-7112
(978) 851-2811

Taxonomy

Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
20116
MA

Other

Enumeration date
12/16/2010
Last updated
12/16/2010
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