Provider Demographics
NPI:1184128191
Name:ORANGE FAMILY DENTAL LLC
Entity type:Organization
Organization Name:ORANGE FAMILY DENTAL LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DISTRICT MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GIAIMO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-291-2773
Mailing Address - Street 1:1 MILITIA DR STE 203
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02421-4703
Mailing Address - Country:US
Mailing Address - Phone:781-862-5958
Mailing Address - Fax:
Practice Address - Street 1:450 W RIVER ST STE 2
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:MA
Practice Address - Zip Code:01364-1440
Practice Address - Country:US
Practice Address - Phone:978-544-2922
Practice Address - Fax:978-544-2922
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-23
Last Update Date:2018-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental