Provider Demographics
NPI:1699223891
Name:STOW ORTHODONTICS
Entity Type:Organization
Organization Name:STOW ORTHODONTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:LUCEY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, MDS
Authorized Official - Phone:978-637-2952
Mailing Address - Street 1:117 GREAT RD
Mailing Address - Street 2:#16
Mailing Address - City:STOW
Mailing Address - State:MA
Mailing Address - Zip Code:01775-1191
Mailing Address - Country:US
Mailing Address - Phone:978-637-2952
Mailing Address - Fax:
Practice Address - Street 1:117 GREAT RD
Practice Address - Street 2:#16
Practice Address - City:STOW
Practice Address - State:MA
Practice Address - Zip Code:01775-1191
Practice Address - Country:US
Practice Address - Phone:978-637-2952
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-15
Last Update Date:2016-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN21591261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental