Provider Demographics
NPI:1467427567
Name:MEDFORD ORAL SURGERY ASSOCIATES, INC.
Entity Type:Organization
Organization Name:MEDFORD ORAL SURGERY ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:JOYCE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:781-395-3100
Mailing Address - Street 1:689 FELLSWAY
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02155-4931
Mailing Address - Country:US
Mailing Address - Phone:781-395-3100
Mailing Address - Fax:781-395-3058
Practice Address - Street 1:689 FELLSWAY
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:MH
Practice Address - Zip Code:02155
Practice Address - Country:US
Practice Address - Phone:781-395-3100
Practice Address - Fax:781-395-3058
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-22
Last Update Date:2009-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA136691223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
70434OtherAETNA US HEALTHCARE
16170OtherHARVARD
70434OtherAETNA US HEALTHCARE