Provider Demographics
NPI:1366158727
Name:PEOPLESDENTAL, P.C.
Entity type:Organization
Organization Name:PEOPLESDENTAL, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LEAH
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:MAYLOTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-874-8198
Mailing Address - Street 1:372 WASHINGTON ST STE 2500
Mailing Address - Street 2:
Mailing Address - City:WELLESLEY
Mailing Address - State:MA
Mailing Address - Zip Code:02481-6216
Mailing Address - Country:US
Mailing Address - Phone:781-226-2440
Mailing Address - Fax:
Practice Address - Street 1:372 WASHINGTON ST STE 2500
Practice Address - Street 2:
Practice Address - City:WELLESLEY
Practice Address - State:MA
Practice Address - Zip Code:02481-6216
Practice Address - Country:US
Practice Address - Phone:781-226-2440
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PEOPLESDENTAL, P.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-01-27
Last Update Date:2023-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty