1942341144 NPI number — ORTHODONTIC CENTERS OF MA INC

Table of content: (NPI 1942341144)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942341144 NPI number — ORTHODONTIC CENTERS OF MA INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ORTHODONTIC CENTERS OF MA INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1942341144
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/14/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
23 COMMERCE WAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SEEKONK
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02771
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-336-4994
Provider Business Mailing Address Fax Number:
508-336-9108

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
23 COMMERCE WAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SEEKONK
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02771
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-336-4994
Provider Business Practice Location Address Fax Number:
508-336-9108
Provider Enumeration Date:
02/09/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
ALEXANDER
Authorized Official First Name:
RICHARD
Authorized Official Middle Name:
Authorized Official Title or Position:
DOCTOR
Authorized Official Telephone Number:
508-336-4994

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  12597 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: RA48576 . This is a "RITECARE" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 0203777 . This is a "MASS HEALTH" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".