Provider Demographics
NPI:1053823401
Name:NEW ENGLAND ORAL SURGERY ASSOCIATES, LLC
Entity Type:Organization
Organization Name:NEW ENGLAND ORAL SURGERY ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:BEANLAND
Authorized Official - Suffix:
Authorized Official - Credentials:MD, DMD
Authorized Official - Phone:978-392-9095
Mailing Address - Street 1:270 LITTLETON ROAD
Mailing Address - Street 2:UNIT 1
Mailing Address - City:WESTFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01886
Mailing Address - Country:US
Mailing Address - Phone:978-392-9095
Mailing Address - Fax:978-392-9912
Practice Address - Street 1:102 SHORE DRIVE
Practice Address - Street 2:SUITE 205
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01605
Practice Address - Country:US
Practice Address - Phone:978-392-9095
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-25
Last Update Date:2017-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN20791204E00000X
MADN21506204E00000X
MADN1855623204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial SurgeryGroup - Single Specialty