Provider Demographics
NPI:1184850091
Name:CENTRAL MA ORTHODONITC ASSOCIATES, PC
Entity Type:Organization
Organization Name:CENTRAL MA ORTHODONITC ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT,TREASURER CMOA, PC
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:GIARRUSSO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:508-753-2489
Mailing Address - Street 1:276 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SPENCER
Mailing Address - State:MA
Mailing Address - Zip Code:01562-1838
Mailing Address - Country:US
Mailing Address - Phone:508-885-2749
Mailing Address - Fax:508-885-0907
Practice Address - Street 1:276 MAIN ST
Practice Address - Street 2:
Practice Address - City:SPENCER
Practice Address - State:MA
Practice Address - Zip Code:01562-1838
Practice Address - Country:US
Practice Address - Phone:508-885-2749
Practice Address - Fax:508-885-0907
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CENTRAL MA ORTHODONTIC ASSOCAITES, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-06-05
Last Update Date:2009-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA177291223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty