Provider Demographics
NPI:1861561664
Name:DENTAL ASSOC OF WAKEFIELD
Entity type:Organization
Organization Name:DENTAL ASSOC OF WAKEFIELD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:N
Authorized Official - Last Name:BOSCIA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:401-789-9718
Mailing Address - Street 1:PO BOX 5370
Mailing Address - Street 2:
Mailing Address - City:WAKEFIELD
Mailing Address - State:RI
Mailing Address - Zip Code:02880
Mailing Address - Country:US
Mailing Address - Phone:401-789-9718
Mailing Address - Fax:401-789-2525
Practice Address - Street 1:4879 TOWER HILL RD
Practice Address - Street 2:
Practice Address - City:WAKEFIELD
Practice Address - State:RI
Practice Address - Zip Code:02879
Practice Address - Country:US
Practice Address - Phone:401-789-9718
Practice Address - Fax:401-789-2525
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty