Provider Demographics
NPI:1508407214
Name:WELLESLEY ORAL SURGERY AND IMPLANT CENTER, PLLC
Entity Type:Organization
Organization Name:WELLESLEY ORAL SURGERY AND IMPLANT CENTER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EMPLOYEE/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:MEMORY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, MD
Authorized Official - Phone:781-235-5225
Mailing Address - Street 1:486 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:WELLESLEY
Mailing Address - State:MA
Mailing Address - Zip Code:02482-5971
Mailing Address - Country:US
Mailing Address - Phone:781-235-5225
Mailing Address - Fax:
Practice Address - Street 1:486 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:WELLESLEY
Practice Address - State:MA
Practice Address - Zip Code:02482-5971
Practice Address - Country:US
Practice Address - Phone:781-235-5225
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-03
Last Update Date:2020-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0112XAmbulatory Health Care FacilitiesClinic/CenterOral and Maxillofacial Surgery