1386107118 NPI number — PEABODY DANVERS ORAL SURGERY, PLLC

Table of content: (NPI 1386107118)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386107118 NPI number — PEABODY DANVERS ORAL SURGERY, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PEABODY DANVERS ORAL SURGERY, PLLC
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:
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NPI Number Information

NPI Number:
1386107118
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/09/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
33 TRAFALGAR SQ STE 201
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NASHUA
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03063-4901
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
603-595-8889
Provider Business Mailing Address Fax Number:
603-595-2027

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
80 LINDALL ST STE 8
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DANVERS
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01923-2135
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
978-777-0505
Provider Business Practice Location Address Fax Number:
978-750-4029
Provider Enumeration Date:
04/09/2019

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
GOY
Authorized Official First Name:
JO
Authorized Official Middle Name:
A
Authorized Official Title or Position:
BILLING COORDINATOR
Authorized Official Telephone Number:
603-595-8889

Provider Taxonomy Codes

  • Taxonomy code: 1223S0112X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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