Provider Demographics
NPI:1447701289
Name:CAPE COD DENTISTRY LLC
Entity type:Organization
Organization Name:CAPE COD DENTISTRY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:HEIDI
Authorized Official - Middle Name:
Authorized Official - Last Name:OLWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-778-1200
Mailing Address - Street 1:262 BARNSTABLE RD
Mailing Address - Street 2:
Mailing Address - City:HYANNIS
Mailing Address - State:MA
Mailing Address - Zip Code:02601-2919
Mailing Address - Country:US
Mailing Address - Phone:508-778-1200
Mailing Address - Fax:508-775-5502
Practice Address - Street 1:262 BARNSTABLE RD
Practice Address - Street 2:
Practice Address - City:HYANNIS
Practice Address - State:MA
Practice Address - Zip Code:02601-2919
Practice Address - Country:US
Practice Address - Phone:508-778-1200
Practice Address - Fax:508-775-5502
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-17
Last Update Date:2016-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA163151223G0001X
MA200471223G0001X
MA188071223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty