Provider Demographics
NPI:1619446713
Name:LEXINGTON IMPLANT AND RESTORATIVE DENTISTRY
Entity Type:Organization
Organization Name:LEXINGTON IMPLANT AND RESTORATIVE DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KRISTA
Authorized Official - Middle Name:NOEL
Authorized Official - Last Name:MANICKAS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:781-862-8223
Mailing Address - Street 1:803 MASSACHUSETTS AVE
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02420-3918
Mailing Address - Country:US
Mailing Address - Phone:781-862-8223
Mailing Address - Fax:
Practice Address - Street 1:803 MASSACHUSETTS AVE
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:MA
Practice Address - Zip Code:02420-3918
Practice Address - Country:US
Practice Address - Phone:781-862-8223
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-19
Last Update Date:2018-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0700XDental ProvidersDentistProsthodonticsGroup - Single Specialty