Main Street Dental
Organization Active NPI Dentist · Edgartown, MA
NPI 1124359773 · NPPES record last updated Jan 21, 2010
Key facts
- NPI
- 1124359773
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Dentist 122300000X
- License
- 19314 (MA)
- Legal business name
- MAIN STREET DENTAL
- Practice address
- 207 Upper Main St
Edgartown, MA 02539-5927 - Phone
- (508) 939-9000
- Fax
- (508) 939-8537
- NPI assigned
- Jan 21, 2010
- Organization subpart
- No
Authorized official
- Name
- Dr. John Clyde Hartley, DDS
- Title
- Owner
- Phone
- (508) 939-9000
Practitioners 1
-
Glenn R Harris, DMD
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist |
122300000X | 19314 | MA | Yes |
Addresses
Primary practice location
207 Upper Main St
Edgartown, MA 02539-5927
Mailing address
PO Box 2135
Edgartown, MA 02539-2135
Phone (508) 939-9000
Other providers in Edgartown, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 21, 2010. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.