Provider Demographics
NPI:1053470740
Name:WORCESTER ORAL SURGERY, P.C.
Entity Type:Organization
Organization Name:WORCESTER ORAL SURGERY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JASJIT
Authorized Official - Middle Name:S
Authorized Official - Last Name:GILL
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:508-852-0021
Mailing Address - Street 1:299 LINCOLN STREET
Mailing Address - Street 2:SUITE 204
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01605-3609
Mailing Address - Country:US
Mailing Address - Phone:508-852-0021
Mailing Address - Fax:508-852-0031
Practice Address - Street 1:299 LINCOLN STREET
Practice Address - Street 2:SUITE 204
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01605-3609
Practice Address - Country:US
Practice Address - Phone:508-852-0021
Practice Address - Fax:508-852-0031
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty