Provider Demographics
NPI:1386732402
Name:ORAL HEALTH IMPACT PROJECT MASSACHUSETTS, LLC
Entity type:Organization
Organization Name:ORAL HEALTH IMPACT PROJECT MASSACHUSETTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:
Authorized Official - Last Name:STOVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:866-316-6447
Mailing Address - Street 1:254 CAFFERTY RD
Mailing Address - Street 2:
Mailing Address - City:PIPERSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18947-9337
Mailing Address - Country:US
Mailing Address - Phone:866-316-6447
Mailing Address - Fax:610-294-7995
Practice Address - Street 1:254 CAFFERTY RD
Practice Address - Street 2:
Practice Address - City:PIPERSVILLE
Practice Address - State:PA
Practice Address - Zip Code:18947-9337
Practice Address - Country:US
Practice Address - Phone:866-316-6447
Practice Address - Fax:610-294-7995
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-11
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty