Procare Dental Inc

Primary specialty

Exclusive Provider OrganizationTaxonomy code 302F00000X

License

21084 Issued in MA

Legal business name

PROCARE DENTAL INC

Practice address

51 Mill St
Suite 4
Hanover, MA 02339-1641

Phone

(508) 743-7888

Fax

(888) 594-4595

NPI assigned

Sep 27, 2011

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Sang Jin Lee, DMD

Title

Owner

Phone

(508) 743-7888

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1317081600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1317945600000",
    "number": "1588947428",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "51 MILL ST",
            "address_2": "SUITE 4",
            "city": "HANOVER",
            "state": "MA",
            "postal_code": "023391641",
            "telephone_number": "508-743-7888",
            "fax_number": "888-594-4555"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "51 MILL ST",
            "address_2": "SUITE 4",
            "city": "HANOVER",
            "state": "MA",
            "postal_code": "023391641",
            "telephone_number": "508-743-7888",
            "fax_number": "888-594-4595"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROCARE DENTAL INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-09-27",
        "last_updated": "2011-10-07",
        "status": "A",
        "authorized_official_last_name": "LEE",
        "authorized_official_first_name": "SANG",
        "authorized_official_middle_name": "JIN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "508-743-7888",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "302F00000X",
            "taxonomy_group": "",
            "desc": "Exclusive Provider Organization",
            "state": "MA",
            "license": "21084",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9762540",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jessica Power, FNP, PMHNP-BC
• Leslie Anne Powers, LMFT
• Catherine Marie Prado -Ona, DMD
• Richard M. Price, DMD
• Primary & Preventive Care, Inc.
• Propel ABA LLC
• Eilis Quinn
• Jill E. Rainone, NP
• Jamison Ratcliffe, DC
• Sarah Rebel, NPP

• Exclusive Provider Organization in Hanover, MA
• Providers in Hanover, MA by specialty
• Exclusive Provider Organization in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 7, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.