Provider Demographics
NPI:1962629352
Name:ORTHODONTIC CENTERS OF MA. INC.
Entity Type:Organization
Organization Name:ORTHODONTIC CENTERS OF MA. INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:ALEXANDER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:508-990-3000
Mailing Address - Street 1:408 STATE RD
Mailing Address - Street 2:ROUTE 6 SUITE 730
Mailing Address - City:DARTMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02747-4302
Mailing Address - Country:US
Mailing Address - Phone:508-990-3000
Mailing Address - Fax:508-990-3080
Practice Address - Street 1:408 STATE RD
Practice Address - Street 2:ROUTE 6 SUITE 730
Practice Address - City:DARTMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02747-4302
Practice Address - Country:US
Practice Address - Phone:508-990-3000
Practice Address - Fax:508-990-3080
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-19
Last Update Date:2009-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA12597122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0203777Medicaid
RIRA48576Medicaid