SOUTHBRIDGE PLACE DENTAL, P.C. (NPI# 1861960270) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1861960270 |
| Entity Type | Organization |
| Organization Name | SOUTHBRIDGE PLACE DENTAL, P.C. |
| Practice Address |
544 Southbridge St Worcester MA 01610-1716 |
| Mailing Address |
1090 Northchase Pkwy Se Ste 290 Marietta GA 30067-6402 |
| Practice Telephone | 7742438592 |
| Enumeration Date | 2018-11-05 |
| Last Update Date | 2018-11-05 |
| Authorized Official Name | DR. DALE MAYFIELD (PRESIDENT) |
| Authorized Official Telephone | 7709165036 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 1223P0106X |
Dentist Specialization: Oral and Maxillofacial Pathology |
Dental Providers | ||
| N | 1223P0221X |
Dentist Specialization: Pediatric Dentistry |
Dental Providers | ||
| N | 1223P0300X |
Dentist Specialization: Periodontics |
Dental Providers | ||
| N | 1223S0112X |
Dentist Specialization: Oral and Maxillofacial Surgery |
Dental Providers | ||
| N | 1223X0400X |
Dentist Specialization: Orthodontics and Dentofacial Orthopedics |
Dental Providers | ||
| Y | 1223G0001X |
Dentist Specialization: General Practice |
Dental Providers |
| Other Name | Type Code |
|---|---|
| Cortland Dental Group | Doing Business As Name - Organization |
| Street Address |
544 SOUTHBRIDGE ST |
| City | WORCESTER |
| State | MA |
| Zip Code | 01610-1716 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1881189355 | Amber Hall | Counselor | 26 Queen St, 6th Floor, Worcester, MA 01610 | 2018-06-27 |
| 1417401951 | Kelsey Moran | Counselor | 1 College Street, Box D, Worcester, MA 01610 | 2016-08-13 |
| 1245685809 | Walter Trisdale | Specialist/Technologist | One College St., College of The Holy Cross, Worcester, MA 01610 | 2016-05-02 |
| 1669866430 | Shannon Smith | Student in an Organized Health Care Education/Training Program | 26 Queen St, Ground Floor, Ambulatory Psychiatry Service, Ummmc, Worcester, MA 01610 | 2015-03-19 |
| 1063815348 | Terri Boettcher | Social Worker | 72 Jacques Street, Worcester, MA 01610 | 2014-10-01 |
| 1700222866 | Kalynn Lucashensky | Occupational Therapist | 105 Woodland St. Apt. A, Worcester, MA 01610 | 2013-05-16 |
| 1093053993 | Chrissy Marie Ryan | Registered Nurse | 26 Queen St 6th Floor, Flow Pact, Worcester, MA 01610 | 2013-01-28 |
| 1851681324 | Renaissance Adult Day Care, LLC | Clinic/Center | 1040 Southbridge Street, Worcester, MA 01610 | 2011-04-18 |
| 1912203217 | Goddard/homestead | Custodial Care Facility | 10 Homestead Avenue, Worcester, MA 01610 | 2011-02-03 |
| 1912173196 | Rahman Ullah | Dentist | Park Ave Dental Center, 456 Park Avenue, Worchester, MA 01610 | 2008-05-07 |
| Find all providers in zip 01610 | ||||
| Taxonomy Code | 1223G0001X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | General Practice |
| A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs. |
| Notes: Source: Academy of General Dentistry |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477190502 | Simply Orthodontics and Pediatrics Worcester, Pllc | Dentist | 200 Lincoln St Ste 6, Worcester, MA 01605-2528 | 2019-12-09 |
| 1821645060 | Wave Dental Pllc | Dentist | 281 Shrewsbury St, Worcester, MA 01604-4623 | 2019-08-22 |
| 1700440658 | Evershine Dental Group PC | Dentist | 100 Mlk Jr Blvd Ste 100, Worcester, MA 01608-1209 | 2019-04-25 |
| 1891234183 | Union Dental Worcester LLC | Dentist | 101 Pleasant St Ste 2010, Worcester, MA 01609-3213 | 2017-02-20 |
| 1659739027 | Ke Dental, PC | Dentist | 64 Highland St, Worcester, MA 01609-2729 | 2016-02-01 |
| 1497139711 | Tarek Ali Elmajie | Dentist | 285 Plantation St Apt 303, Worcester, MA 01604-7707 | 2015-07-16 |
| 1518363118 | Bhavana Agadi Dmd LLC | Dentist | 1241 Main St Unit 8, Worcester, MA 01603-1842 | 2014-11-08 |
| 1912306135 | Neighborhood Dental Group, PC | Dentist | 111 Elm St Suite 203, Worcester, MA 01609 | 2014-08-14 |
| 1134538416 | Neighborhood Dental Group PC | Dentist | 111 Elm St Ste 203, Worcester, MA 01609-1967 | 2014-08-12 |
| 1457784407 | Mohamed Hazem Farid Elnazer | Dentist | 1438 Grafton St, Worcester, MA 01604-2721 | 2013-08-14 |
| Find all providers in WORCESTER | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.