Provider Demographics
NPI:1205007978
Name:CHELSEA ORTHODONTICS, P.C
Entity Type:Organization
Organization Name:CHELSEA ORTHODONTICS, P.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:GORDON
Authorized Official - Last Name:LEPINGWELL
Authorized Official - Suffix:JR
Authorized Official - Credentials:DMD
Authorized Official - Phone:617-889-1990
Mailing Address - Street 1:131 ARLINGTON ST
Mailing Address - Street 2:
Mailing Address - City:CHELSEA
Mailing Address - State:MA
Mailing Address - Zip Code:02150-2310
Mailing Address - Country:US
Mailing Address - Phone:617-889-1990
Mailing Address - Fax:617-889-1991
Practice Address - Street 1:131 ARLINGTON ST
Practice Address - Street 2:
Practice Address - City:CHELSEA
Practice Address - State:MA
Practice Address - Zip Code:02150-2310
Practice Address - Country:US
Practice Address - Phone:617-889-1990
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-20
Last Update Date:2008-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA190391223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA280429Medicaid
MAX07667OtherBLUE CROSS BLUE SHIELD