Provider Demographics
NPI:1023202256
Name:FAMILY ORTHODONTICS OF CAMBRIDGE
Entity Type:Organization
Organization Name:FAMILY ORTHODONTICS OF CAMBRIDGE
Other - Org Name:FAMILY ORTHODONTICS OF HUDSON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ORTHODONTIST / PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LAKSHMI
Authorized Official - Middle Name:P
Authorized Official - Last Name:THALANKI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, MS
Authorized Official - Phone:617-625-1714
Mailing Address - Street 1:182 ELM ST N
Mailing Address - Street 2:DAVIS SQ
Mailing Address - City:N. CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02140-1302
Mailing Address - Country:US
Mailing Address - Phone:617-625-1714
Mailing Address - Fax:617-625-1758
Practice Address - Street 1:182 ELM ST N
Practice Address - Street 2:DAVIS SQ
Practice Address - City:N. CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02140-1302
Practice Address - Country:US
Practice Address - Phone:617-625-1714
Practice Address - Fax:617-625-1758
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-30
Last Update Date:2007-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA196741223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty