Provider Demographics
NPI:1063672269
Name:MASSOD, LINDA JAY (DMD,)
Entity Type:Individual
Prefix:MS
First Name:LINDA
Middle Name:JAY
Last Name:MASSOD
Suffix:
Gender:F
Credentials:DMD,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:85 CONSTITUTION LN
Mailing Address - Street 2:2G
Mailing Address - City:DANVERS
Mailing Address - State:MA
Mailing Address - Zip Code:01923-3694
Mailing Address - Country:US
Mailing Address - Phone:978-774-4505
Mailing Address - Fax:978-762-7470
Practice Address - Street 1:85 CONSTITUTION LN
Practice Address - Street 2:2G
Practice Address - City:DANVERS
Practice Address - State:MA
Practice Address - Zip Code:01923-3694
Practice Address - Country:US
Practice Address - Phone:978-774-4505
Practice Address - Fax:978-762-7470
Is Sole Proprietor?:No
Enumeration Date:2008-06-11
Last Update Date:2008-06-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA0179451223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice