Provider Demographics
NPI:1376760413
Name:NEPONSET VALLEY ORAL AND MAXILLOFACIAL SURGERY ASSOCIATES, PLLC
Entity Type:Organization
Organization Name:NEPONSET VALLEY ORAL AND MAXILLOFACIAL SURGERY ASSOCIATES, PLLC
Other - Org Name:LAWRENCE T. HERMAN, DMD, PC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:T
Authorized Official - Last Name:HERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, MD
Authorized Official - Phone:508-660-2900
Mailing Address - Street 1:841 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:WALPOLE
Mailing Address - State:MA
Mailing Address - Zip Code:02081-2997
Mailing Address - Country:US
Mailing Address - Phone:508-660-2900
Mailing Address - Fax:508-660-0134
Practice Address - Street 1:841 MAIN ST
Practice Address - Street 2:
Practice Address - City:WALPOLE
Practice Address - State:MA
Practice Address - Zip Code:02081-2997
Practice Address - Country:US
Practice Address - Phone:508-660-2900
Practice Address - Fax:508-660-0134
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-19
Last Update Date:2021-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA125481223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty