Provider Demographics
NPI:1245820851
Name:ORANGE BLOSSOM DENTAL PLLC
Entity type:Organization
Organization Name:ORANGE BLOSSOM DENTAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GENEVIEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:GARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:DM
Authorized Official - Phone:978-438-2128
Mailing Address - Street 1:40 PARK ST
Mailing Address - Street 2:
Mailing Address - City:PEPPERELL
Mailing Address - State:MA
Mailing Address - Zip Code:01463-1192
Mailing Address - Country:US
Mailing Address - Phone:978-433-2128
Mailing Address - Fax:
Practice Address - Street 1:40 PARK ST
Practice Address - Street 2:
Practice Address - City:PEPPERELL
Practice Address - State:MA
Practice Address - Zip Code:01463-1192
Practice Address - Country:US
Practice Address - Phone:978-433-2128
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-19
Last Update Date:2021-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty