Provider Demographics
NPI:1447284765
Name:SHARON MOUGHAN DDS, K BRUCE RIEDELL DDS, PC
Entity type:Organization
Organization Name:SHARON MOUGHAN DDS, K BRUCE RIEDELL DDS, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:MOUGHAN
Authorized Official - Last Name:RIEDELL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:978-372-6800
Mailing Address - Street 1:10 DOANE ST
Mailing Address - Street 2:
Mailing Address - City:BRADFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01835-7405
Mailing Address - Country:US
Mailing Address - Phone:978-372-6800
Mailing Address - Fax:
Practice Address - Street 1:10 DOANE ST
Practice Address - Street 2:
Practice Address - City:BRADFORD
Practice Address - State:MA
Practice Address - Zip Code:01835-7405
Practice Address - Country:US
Practice Address - Phone:978-372-6800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty