Provider Demographics
NPI:1356460810
Name:MERRIMACK VALLEY ORAL SURGEONS, INC
Entity Type:Organization
Organization Name:MERRIMACK VALLEY ORAL SURGEONS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KATE
Authorized Official - Middle Name:
Authorized Official - Last Name:ACKERMANN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-438-7206
Mailing Address - Street 1:88 MONTVALE AVE
Mailing Address - Street 2:STE 5
Mailing Address - City:STONEHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02180-3643
Mailing Address - Country:US
Mailing Address - Phone:781-438-7206
Mailing Address - Fax:781-279-9029
Practice Address - Street 1:88 MONTVALE AVE
Practice Address - Street 2:STE 5
Practice Address - City:STONEHAM
Practice Address - State:MA
Practice Address - Zip Code:02180-3643
Practice Address - Country:US
Practice Address - Phone:781-438-7206
Practice Address - Fax:781-279-9029
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9774459Medicaid
MA702431BOtherTUFTS
MAX10741OtherBCBS
MA9774459Medicaid