Provider Demographics
NPI:1093723074
Name:SCITUATE ORTHODONTICS, INC
Entity Type:Organization
Organization Name:SCITUATE ORTHODONTICS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAY
Authorized Official - Middle Name:TALBOT
Authorized Official - Last Name:HODGE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:781-545-3466
Mailing Address - Street 1:255 CHIEF JUSTICE CUSHING HWY
Mailing Address - Street 2:
Mailing Address - City:SCITUATE
Mailing Address - State:MA
Mailing Address - Zip Code:02066-4442
Mailing Address - Country:US
Mailing Address - Phone:781-545-3466
Mailing Address - Fax:
Practice Address - Street 1:255 CHIEF JUSTICE CUSHING HWY
Practice Address - Street 2:
Practice Address - City:SCITUATE
Practice Address - State:MA
Practice Address - Zip Code:02066-4442
Practice Address - Country:US
Practice Address - Phone:781-545-3466
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA180701223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty