Provider Demographics
NPI:1871647354
Name:H IVAN ORUP JR DMD MMSC PC
Entity Type:Organization
Organization Name:H IVAN ORUP JR DMD MMSC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT ORTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:HANS
Authorized Official - Middle Name:IVAN
Authorized Official - Last Name:ORUP
Authorized Official - Suffix:JR
Authorized Official - Credentials:DMD MMSC
Authorized Official - Phone:978-369-3690
Mailing Address - Street 1:290 BAKER AVENUE SUITE 204
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:MA
Mailing Address - Zip Code:01742
Mailing Address - Country:US
Mailing Address - Phone:978-369-3690
Mailing Address - Fax:978-369-3256
Practice Address - Street 1:290 BAKER AVENUE SUITE 204
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:MA
Practice Address - Zip Code:01742
Practice Address - Country:US
Practice Address - Phone:978-369-3690
Practice Address - Fax:978-369-3256
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA183511223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty