Provider Demographics
NPI:1619015567
Name:MERRIMACK VALLEY DENTISTRY P.C.
Entity Type:Organization
Organization Name:MERRIMACK VALLEY DENTISTRY P.C.
Other - Org Name:JASON PUJO D.M.D., PC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:PETER
Authorized Official - Last Name:PUJO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:978-957-1898
Mailing Address - Street 1:144 ARLINGTON STREET
Mailing Address - Street 2:
Mailing Address - City:DRACUT
Mailing Address - State:MA
Mailing Address - Zip Code:01826
Mailing Address - Country:US
Mailing Address - Phone:978-957-1898
Mailing Address - Fax:978-957-6262
Practice Address - Street 1:144 ARLINGTON STREET
Practice Address - Street 2:
Practice Address - City:DRACUT
Practice Address - State:MA
Practice Address - Zip Code:01826
Practice Address - Country:US
Practice Address - Phone:978-957-1898
Practice Address - Fax:978-957-6262
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-02
Last Update Date:2014-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA193741223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty