Provider Demographics
NPI:1750720918
Name:JASON A BOCH DMD LLC
Entity type:Organization
Organization Name:JASON A BOCH DMD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:A
Authorized Official - Last Name:BOCH
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:508-358-0150
Mailing Address - Street 1:45 MEADOWBROOK CIR
Mailing Address - Street 2:
Mailing Address - City:SUDBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01776-2641
Mailing Address - Country:US
Mailing Address - Phone:978-443-2108
Mailing Address - Fax:
Practice Address - Street 1:109 ANDREW AVE
Practice Address - Street 2:STE 201
Practice Address - City:WAYLAND
Practice Address - State:MA
Practice Address - Zip Code:01778
Practice Address - Country:US
Practice Address - Phone:508-358-0150
Practice Address - Fax:508-358-0131
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-21
Last Update Date:2013-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA19000261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental