Provider Demographics
NPI:1003251398
Name:BURLINGTON ORAL AND FACIAL SURGERY CENTER LLC
Entity Type:Organization
Organization Name:BURLINGTON ORAL AND FACIAL SURGERY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:G
Authorized Official - Last Name:PACE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:781-272-0800
Mailing Address - Street 1:77 SOUTH BEDFORD STREET
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BURLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01803
Mailing Address - Country:US
Mailing Address - Phone:781-272-0800
Mailing Address - Fax:
Practice Address - Street 1:77 S BEDFORD ST
Practice Address - Street 2:SUITE 100
Practice Address - City:BURLINGTON
Practice Address - State:MA
Practice Address - Zip Code:01803-5115
Practice Address - Country:US
Practice Address - Phone:781-272-0800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-01
Last Update Date:2014-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN18558321223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1184678930Medicare UPIN
MA1184609018Medicare UPIN