Provider Demographics
NPI:1174705792
Name:DENNIS J AHERN DDS PC
Entity type:Organization
Organization Name:DENNIS J AHERN DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:AHERN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:508-485-1800
Mailing Address - Street 1:222 BOLTON STREET
Mailing Address - Street 2:
Mailing Address - City:MARLBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01752
Mailing Address - Country:US
Mailing Address - Phone:508-485-1800
Mailing Address - Fax:508-485-1808
Practice Address - Street 1:222 BOLTON STREET
Practice Address - Street 2:
Practice Address - City:MARLBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01752
Practice Address - Country:US
Practice Address - Phone:508-485-1800
Practice Address - Fax:508-485-1808
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-05
Last Update Date:2007-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
X12309OtherBLUE CROSS BLUE SHIELD IN