Provider Demographics
NPI:1790149987
Name:CAPESIDE ORAL&FACIAL SURGERY, INC.
Entity Type:Organization
Organization Name:CAPESIDE ORAL&FACIAL SURGERY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:LATIMER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS,MD
Authorized Official - Phone:508-645-6576
Mailing Address - Street 1:362 GIFFORD ST
Mailing Address - Street 2:
Mailing Address - City:FALMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02540-2912
Mailing Address - Country:US
Mailing Address - Phone:508-645-6576
Mailing Address - Fax:508-645-6580
Practice Address - Street 1:362 GIFFORD ST
Practice Address - Street 2:
Practice Address - City:FALMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02540-2912
Practice Address - Country:US
Practice Address - Phone:508-645-6576
Practice Address - Fax:508-645-6580
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-13
Last Update Date:2016-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN18550541223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty