Provider Demographics
NPI:1912020512
Name:ORAL SURGERY SOUTH PC
Entity Type:Organization
Organization Name:ORAL SURGERY SOUTH PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:C
Authorized Official - Last Name:CATAUDELLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-871-1677
Mailing Address - Street 1:80 WASHINGTON ST
Mailing Address - Street 2:BLD N-51
Mailing Address - City:NORWELL
Mailing Address - State:MA
Mailing Address - Zip Code:02061-1740
Mailing Address - Country:US
Mailing Address - Phone:781-871-1677
Mailing Address - Fax:781-982-4094
Practice Address - Street 1:80 WASHINGTON ST
Practice Address - Street 2:N-51
Practice Address - City:NORWELL
Practice Address - State:MA
Practice Address - Zip Code:02061-1740
Practice Address - Country:US
Practice Address - Phone:781-871-1677
Practice Address - Fax:781-982-4094
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA189231223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty