Provider Demographics
NPI:1205436276
Name:THE NURTURE FRENECTOMY CENTER
Entity type:Organization
Organization Name:THE NURTURE FRENECTOMY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LAUREN
Authorized Official - Middle Name:
Authorized Official - Last Name:BALLINGER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:413-329-3292
Mailing Address - Street 1:193 OSCEOLA RD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:MA
Mailing Address - Zip Code:01254-5211
Mailing Address - Country:US
Mailing Address - Phone:443-610-7590
Mailing Address - Fax:
Practice Address - Street 1:200 ELM ST STE 1
Practice Address - Street 2:
Practice Address - City:PITTSFIELD
Practice Address - State:MA
Practice Address - Zip Code:01201-6551
Practice Address - Country:US
Practice Address - Phone:413-329-3292
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-29
Last Update Date:2020-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
MADN1888264OtherMA DENTAL LICENSE