Provider Demographics
NPI:1437276698
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:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOS
Authorized Official - Middle Name:
Authorized Official - Last Name:BACOS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:978-454-5637
Mailing Address - Street 1:33 BARTLETT ST
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:MA
Mailing Address - Zip Code:01852-1334
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:33 BARTLETT ST
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01852-1334
Practice Address - Country:US
Practice Address - Phone:978-454-5637
Practice Address - Fax:978-458-5467
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9732322Medicaid
MAD215OtherHARVARD PILGRIM
MA702431OtherTUFTS HEALTH PLAN
MAX10710OtherBCBS OF MA
MAX10710OtherBCBS OF MA