Provider Demographics
NPI:1982738209
Name:ORANGE DENTAL GROUP LLC
Entity Type:Organization
Organization Name:ORANGE DENTAL GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DWIGHT
Authorized Official - Middle Name:K
Authorized Official - Last Name:STOWELL
Authorized Official - Suffix:JR
Authorized Official - Credentials:DMD
Authorized Official - Phone:978-249-8545
Mailing Address - Street 1:9 GROVE ST
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:MA
Mailing Address - Zip Code:01364-1009
Mailing Address - Country:US
Mailing Address - Phone:978-544-3515
Mailing Address - Fax:978-544-2104
Practice Address - Street 1:9 GROVE ST
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:MA
Practice Address - Zip Code:01364-1009
Practice Address - Country:US
Practice Address - Phone:978-544-3515
Practice Address - Fax:978-544-2104
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-16
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA127361223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAX12693OtherBLUECROSS BLUESHIELD OF MA
MA922OtherDELTA DENTAL
MA9794298Medicaid