1841454980 NPI number — ORAL AND FACIAL SURGERY ASSOCIATES,PLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841454980 NPI number — ORAL AND FACIAL SURGERY ASSOCIATES,PLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ORAL AND FACIAL SURGERY ASSOCIATES,PLC
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:
6
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:
1841454980
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/16/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3 DALTON AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PITTSFIELD
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01201-3501
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
413-499-8400
Provider Business Mailing Address Fax Number:
413-499-8411

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3 DALTON AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PITTSFIELD
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01201-3501
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
413-499-8400
Provider Business Practice Location Address Fax Number:
413-499-8411
Provider Enumeration Date:
07/17/2008

Additional Information

Authorized Official

Authorized Official Last Name:
ZITER
Authorized Official First Name:
TINA
Authorized Official Middle Name:
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
413-664-4100

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1008284 , issued by the state of ( VT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 9721533 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".




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