Provider Demographics
NPI:1003982786
Name:CENTRAL MA ORTHODONTIC ASSOCIATES PC
Entity Type:Organization
Organization Name:CENTRAL MA ORTHODONTIC ASSOCIATES PC
Other - Org Name:CMOA PC
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT TREASURE CMOA PC ORTHODON
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:GIARRUSSO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:508-753-2489
Mailing Address - Street 1:100 MLK JR BLVD
Mailing Address - Street 2:SUITE 500
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01608-1209
Mailing Address - Country:US
Mailing Address - Phone:508-753-2489
Mailing Address - Fax:508-795-3892
Practice Address - Street 1:100 MLK JR. BOULEVARD
Practice Address - Street 2:SUITE 500
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01608-1209
Practice Address - Country:US
Practice Address - Phone:508-753-2489
Practice Address - Fax:508-795-3892
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CENTRAL MA ORTHODONTIC ASSOCIATES PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-11-27
Last Update Date:2015-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty