Provider Demographics
NPI:1023295011
Name:MILFORD ORTHODONTIC ASSOCIATES
Entity type:Organization
Organization Name:MILFORD ORTHODONTIC ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:ASSIOUN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:508-473-4220
Mailing Address - Street 1:189 MAIN ST
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:MILFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01757-2627
Mailing Address - Country:US
Mailing Address - Phone:508-473-4220
Mailing Address - Fax:
Practice Address - Street 1:189 MAIN ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:MILFORD
Practice Address - State:MA
Practice Address - Zip Code:01757-2627
Practice Address - Country:US
Practice Address - Phone:508-473-4220
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-22
Last Update Date:2008-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA202091223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty