Provider Demographics
NPI:1841454980
Name:ORAL AND FACIAL SURGERY ASSOCIATES,PLC
Entity type:Organization
Organization Name:ORAL AND FACIAL SURGERY ASSOCIATES,PLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:TINA
Authorized Official - Middle Name:
Authorized Official - Last Name:ZITER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:413-664-4100
Mailing Address - Street 1:3 DALTON AVE
Mailing Address - Street 2:
Mailing Address - City:PITTSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01201-3501
Mailing Address - Country:US
Mailing Address - Phone:413-499-8400
Mailing Address - Fax:413-499-8411
Practice Address - Street 1:3 DALTON AVE
Practice Address - Street 2:
Practice Address - City:PITTSFIELD
Practice Address - State:MA
Practice Address - Zip Code:01201-3501
Practice Address - Country:US
Practice Address - Phone:413-499-8400
Practice Address - Fax:413-499-8411
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-17
Last Update Date:2012-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1008284Medicaid
MA9721533Medicaid
VTVN2787Medicare PIN
MAX10718Medicare PIN