Main Street Dental

NPI #1124359773 in Edgartown, Massachusetts

Provider Information

NPI Number: 1124359773
Entity Type: Organization
Organization Name: Main Street Dental
Primary Specialty: Dentist
Enumeration Date: Jan 21, 2010
Last Updated: Jan 21, 2010

Practice Location

Address: 207 UPPER MAIN ST
City: Edgartown
State: Massachusetts
ZIP Code: 02539-5927
Phone: (508) 939-9000

Authorized Official

Name: DR. JOHN CLYDE HARTLEY, DDS
Title: OWNER
Phone: (508) 939-9000

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist	122300000X	Primary

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