Provider Demographics
NPI: | 1639316755 |
---|---|
Name: | MASHPEE ORTHODONTICS, PC |
Entity Type: | Organization |
Organization Name: | MASHPEE ORTHODONTICS, PC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | PRESIDENT |
Authorized Official - Prefix: | |
Authorized Official - First Name: | NICHOLAS |
Authorized Official - Middle Name: | P |
Authorized Official - Last Name: | ZAFIROPOULOS |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | DMD |
Authorized Official - Phone: | 508-539-0355 |
Mailing Address - Street 1: | PO BOX 2217 |
Mailing Address - Street 2: | |
Mailing Address - City: | MASHPEE |
Mailing Address - State: | MA |
Mailing Address - Zip Code: | 02649-8217 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 508-539-0355 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 2 OAK STREET SUITE 204 |
Practice Address - Street 2: | |
Practice Address - City: | MASHPEE |
Practice Address - State: | MA |
Practice Address - Zip Code: | 02649-8217 |
Practice Address - Country: | US |
Practice Address - Phone: | 508-539-0355 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2009-01-12 |
Last Update Date: | 2009-01-12 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
MA | 19006 | 1223X0400X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 1223X0400X | Dental Providers | Dentist | Orthodontics and Dentofacial Orthopedics | Group - Single Specialty |