Provider Demographics
NPI:1659679942
Name:MS ORTHODONTICS ASSOCIATES BOXBOROUGH LLC
Entity Type:Organization
Organization Name:MS ORTHODONTICS ASSOCIATES BOXBOROUGH LLC
Other - Org Name:BOXBOROUGH ORTHODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANNA
Authorized Official - Middle Name:KARINA
Authorized Official - Last Name:SIMON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:978-264-9797
Mailing Address - Street 1:629 MASS AVE
Mailing Address - Street 2:
Mailing Address - City:BOXBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01719-1528
Mailing Address - Country:US
Mailing Address - Phone:978-264-9797
Mailing Address - Fax:978-264-9798
Practice Address - Street 1:629 MASS AVE
Practice Address - Street 2:
Practice Address - City:BOXBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01719-1528
Practice Address - Country:US
Practice Address - Phone:978-264-9797
Practice Address - Fax:978-264-9798
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MS ORTHODONTICS ASSOCIATES LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-03-10
Last Update Date:2011-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA210771223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty