Provider Demographics
NPI:1427460336
Name:WESTBORO ORTHODONTIC ASSOCIATES, LLC
Entity type:Organization
Organization Name:WESTBORO ORTHODONTIC ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:R
Authorized Official - Last Name:WEBB
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:508-366-4800
Mailing Address - Street 1:210 TURNPIKE RD
Mailing Address - Street 2:
Mailing Address - City:WESTBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01581-2880
Mailing Address - Country:US
Mailing Address - Phone:508-366-4800
Mailing Address - Fax:508-366-7680
Practice Address - Street 1:210 TURNPIKE RD
Practice Address - Street 2:
Practice Address - City:WESTBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01581-2880
Practice Address - Country:US
Practice Address - Phone:508-366-4800
Practice Address - Fax:508-366-7680
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-27
Last Update Date:2014-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty