| Aqua Dental Llc | |
|
1395 N Main St Randolph MA 02368-1768 | |
| (781) 963-6077 | |
| Not Available |
| Full Name | Aqua Dental Llc |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 1395 N Main St, Randolph, Massachusetts |
| Authorized Official Name and Position | Jeffrey Fayerman (OWNER) |
| Authorized Official Contact | 7819636077 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Aqua Dental Llc 1395 N Main St Randolph MA 02368-1768 Ph: (781) 963-6077 | Aqua Dental Llc 1395 N Main St Randolph MA 02368-1768 Ph: (781) 963-6077 |
| NPI Number | 1336392505 |
|---|---|
| Provider Enumeration Date | 10/31/2008 |
| Last Update Date | 10/31/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1336392505 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | 18450 (Massachusetts) | Primary |
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