1457375107 NPI number — COMMONWEALTH ORAL & MAXILLOFACIAL SURGICAL ASSOCIATES INC.

Table of content: (NPI 1457375107)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457375107 NPI number — COMMONWEALTH ORAL & MAXILLOFACIAL SURGICAL ASSOCIATES INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COMMONWEALTH ORAL & MAXILLOFACIAL SURGICAL ASSOCIATES 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:
1457375107
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/04/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2353 MASSACHUSETTS AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CAMBRIDGE
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02140-1252
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
617-492-8700
Provider Business Mailing Address Fax Number:
617-492-0698

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2353 MASSACHUSETTS AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CAMBRIDGE
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02140-1252
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
617-492-8700
Provider Business Practice Location Address Fax Number:
617-492-0698
Provider Enumeration Date:
07/26/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
LECHTENBERG
Authorized Official First Name:
EDWARD
Authorized Official Middle Name:
L
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
617-492-8700

Provider Taxonomy Codes

  • Taxonomy code: 1223S0112X , with the licence number:  10823 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 1223S0112X , with the licence number: 15441 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1223S0112X , with the licence number: 20462 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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