Provider Demographics
NPI:1689772477
Name:LOWELL ORAL SURGERY ASSOCIATES, INC
Entity Type:Organization
Organization Name:LOWELL ORAL SURGERY ASSOCIATES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:D
Authorized Official - Last Name:STONE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD MD
Authorized Official - Phone:978-458-1264
Mailing Address - Street 1:33 BARTLETT ST
Mailing Address - Street 2:SUITE 405
Mailing Address - City:LOWELL
Mailing Address - State:MA
Mailing Address - Zip Code:01852-1334
Mailing Address - Country:US
Mailing Address - Phone:978-458-1264
Mailing Address - Fax:
Practice Address - Street 1:33 BARTLETT ST
Practice Address - Street 2:SUITE 405
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01852-1334
Practice Address - Country:US
Practice Address - Phone:978-458-1264
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2016-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0106XDental ProvidersDentistOral and Maxillofacial PathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NHRE5851Medicare PIN
MAM10800Medicare PIN