Provider Demographics
NPI:1730312869
Name:CENTRAL ORTHODONTIC ASSOCIATES INC
Entity Type:Organization
Organization Name:CENTRAL ORTHODONTIC ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:F
Authorized Official - Last Name:ASSIOUN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:978-345-6911
Mailing Address - Street 1:100 WHALON ST STE 1A
Mailing Address - Street 2:
Mailing Address - City:FITCHBURG
Mailing Address - State:MA
Mailing Address - Zip Code:01420-7162
Mailing Address - Country:US
Mailing Address - Phone:978-345-6911
Mailing Address - Fax:
Practice Address - Street 1:100 WHALON ST STE 1A
Practice Address - Street 2:
Practice Address - City:FITCHBURG
Practice Address - State:MA
Practice Address - Zip Code:01420-7162
Practice Address - Country:US
Practice Address - Phone:978-345-6911
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-24
Last Update Date:2009-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA202091223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty