Provider Demographics
NPI:1568409902
Name:MELROSE WAKEFIELD ORAL SURGERY INC.
Entity Type:Organization
Organization Name:MELROSE WAKEFIELD ORAL SURGERY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JANET
Authorized Official - Middle Name:
Authorized Official - Last Name:NIGHTINGALE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-662-6228
Mailing Address - Street 1:810 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MELROSE
Mailing Address - State:MA
Mailing Address - Zip Code:02176-2711
Mailing Address - Country:US
Mailing Address - Phone:781-662-6228
Mailing Address - Fax:781-662-4455
Practice Address - Street 1:810 MAIN ST
Practice Address - Street 2:
Practice Address - City:MELROSE
Practice Address - State:MA
Practice Address - Zip Code:02176-2711
Practice Address - Country:US
Practice Address - Phone:781-662-6228
Practice Address - Fax:781-662-4455
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-02
Last Update Date:2015-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty