Provider Demographics
NPI:1548861339
Name:LEXINGTON DENTAL GROUP LLC
Entity type:Organization
Organization Name:LEXINGTON DENTAL GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LORRAINE
Authorized Official - Middle Name:
Authorized Official - Last Name:MATHEUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-562-0457
Mailing Address - Street 1:35 BEDFORD ST STE 16
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02420-4440
Mailing Address - Country:US
Mailing Address - Phone:781-863-0096
Mailing Address - Fax:978-922-6727
Practice Address - Street 1:35 BEDFORD ST STE 110
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:MA
Practice Address - Zip Code:02420-4320
Practice Address - Country:US
Practice Address - Phone:781-674-9995
Practice Address - Fax:978-922-6727
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-06
Last Update Date:2020-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty