Provider Demographics
NPI:1851464945
Name:FRAMINGHAM ORAL AND MAXILLOFACIAL SURGERY PC
Entity Type:Organization
Organization Name:FRAMINGHAM ORAL AND MAXILLOFACIAL SURGERY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:M
Authorized Official - Last Name:EMANUEL
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, MD
Authorized Official - Phone:508-879-1300
Mailing Address - Street 1:29 LINCOLN ST.
Mailing Address - Street 2:
Mailing Address - City:FRAMINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01702
Mailing Address - Country:US
Mailing Address - Phone:508-879-1300
Mailing Address - Fax:508-879-1388
Practice Address - Street 1:29 LINCOLN ST.
Practice Address - Street 2:
Practice Address - City:FRAMINGHAM
Practice Address - State:MA
Practice Address - Zip Code:01702
Practice Address - Country:US
Practice Address - Phone:508-879-1300
Practice Address - Fax:508-879-1388
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-16
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAX20157Medicare PIN