Provider Demographics
NPI:1003043514
Name:LAHAIR & GALLAGHER PEDIATRIC DENTISTRY, LLC
Entity Type:Organization
Organization Name:LAHAIR & GALLAGHER PEDIATRIC DENTISTRY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:RAYMOND
Authorized Official - Last Name:LAHAIR
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:508-667-5246
Mailing Address - Street 1:1000 OLD CONNECTICUT PATH
Mailing Address - Street 2:
Mailing Address - City:FRAMINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01701-4249
Mailing Address - Country:US
Mailing Address - Phone:508-877-3337
Mailing Address - Fax:508-877-3337
Practice Address - Street 1:102 SHORE DR
Practice Address - Street 2:SUITE 302
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01605-3154
Practice Address - Country:US
Practice Address - Phone:508-854-9994
Practice Address - Fax:508-854-9996
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-11
Last Update Date:2009-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA213331223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty