Provider Demographics
NPI:1063659852
Name:JOSEPH R. PELUSO
Entity Type:Organization
Organization Name:JOSEPH R. PELUSO
Other - Org Name:BORDERLAND ORTHODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:SAVOY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-238-1119
Mailing Address - Street 1:115 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:NORTH EASTON
Mailing Address - State:MA
Mailing Address - Zip Code:02356
Mailing Address - Country:US
Mailing Address - Phone:508-238-1119
Mailing Address - Fax:508-238-2448
Practice Address - Street 1:115 MAIN ST
Practice Address - Street 2:
Practice Address - City:NORTH EASTON
Practice Address - State:MA
Practice Address - Zip Code:02356-1468
Practice Address - Country:US
Practice Address - Phone:508-238-1119
Practice Address - Fax:508-238-2448
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-15
Last Update Date:2009-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA125371223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9796053Medicaid