Provider Demographics
NPI:1548584659
Name:ORTHODONTICS OF CAMBRIDGE, PC
Entity Type:Organization
Organization Name:ORTHODONTICS OF CAMBRIDGE, PC
Other - Org Name:MURTHY, NELSON & HERTZBERG
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:U
Authorized Official - Last Name:MURTHY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:813-957-5944
Mailing Address - Street 1:186 CONCORD AVENUE
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02138-2318
Mailing Address - Country:US
Mailing Address - Phone:617-864-2003
Mailing Address - Fax:617-864-2004
Practice Address - Street 1:186 CONCORD AVENUE
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02138-2318
Practice Address - Country:US
Practice Address - Phone:617-864-2003
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-18
Last Update Date:2010-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN18552021223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty