Provider Demographics
NPI:1194110726
Name:ORTHODONTIC SPECIALISTS OF SOUTHEASTERN MA
Entity type:Organization
Organization Name:ORTHODONTIC SPECIALISTS OF SOUTHEASTERN MA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ORTHODONTIST
Authorized Official - Prefix:MR
Authorized Official - First Name:NEIL
Authorized Official - Middle Name:L
Authorized Official - Last Name:OLIVEIRA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:508-947-8209
Mailing Address - Street 1:47 BEDFORD STREET
Mailing Address - Street 2:UNIT 4
Mailing Address - City:MIDDLEBORO
Mailing Address - State:MA
Mailing Address - Zip Code:02346
Mailing Address - Country:US
Mailing Address - Phone:508-947-8209
Mailing Address - Fax:508-947-3714
Practice Address - Street 1:47 BEDFORD STREET
Practice Address - Street 2:UNIT 4
Practice Address - City:MIDDLEBORO
Practice Address - State:MA
Practice Address - Zip Code:02346
Practice Address - Country:US
Practice Address - Phone:508-947-8209
Practice Address - Fax:508-947-3714
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-31
Last Update Date:2017-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental