Provider Demographics
NPI:1033463856
Name:WESTBOROUGH DENTAL PC
Entity type:Organization
Organization Name:WESTBOROUGH DENTAL PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHELSEA
Authorized Official - Middle Name:
Authorized Official - Last Name:PERRY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:617-678-6266
Mailing Address - Street 1:18 LYMAN ST
Mailing Address - Street 2:SUITE 105
Mailing Address - City:WESTBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01581-1459
Mailing Address - Country:US
Mailing Address - Phone:508-366-8808
Mailing Address - Fax:508-366-8808
Practice Address - Street 1:18 LYMAN ST
Practice Address - Street 2:SUITE 105
Practice Address - City:WESTBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01581-1459
Practice Address - Country:US
Practice Address - Phone:508-366-8808
Practice Address - Fax:508-366-8808
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-31
Last Update Date:2012-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN1855146261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental