Basic Information
Provider Information
NPI: 1881715332
EntityType: 2
ReplacementNPI:  
OrganizationName: HARBOR HEALTH SERVICES, INC
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName: ELLEN JONES COMMUNITY DENTAL CENTER
OtherOrganizationType: 3
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1135 MORTON STREET
Address2:  
City: MATTAPAN
State: MA
PostalCode: 021262834
CountryCode: US
TelephoneNumber: 6175332300
FaxNumber: 6175332301
Practice Location
Address1: 516 ROUTE 134 STE 12
Address2:  
City: SOUTH DENNIS
State: MA
PostalCode: 026603430
CountryCode: US
TelephoneNumber: 5084307710
FaxNumber: 5084301599
Other Information
ProviderEnumerationDate: 04/03/2007
LastUpdateDate: 06/11/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: JONES
AuthorizedOfficialFirstName: CHARLES
AuthorizedOfficialMiddleName: T.
AuthorizedOfficialTitleorPosition: PRESIDENT & CEO
AuthorizedOfficialTelephone: 6175332300
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 06/11/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
261QD0000X  Y Ambulatory Health Care FacilitiesClinic/CenterDental

No ID Information.


Home