Provider Demographics
NPI:1720245228
Name:NELSON AND HERTZBERG ORTHODONTICS OF CAMBRIDGE LLC
Entity type:Organization
Organization Name:NELSON AND HERTZBERG ORTHODONTICS OF CAMBRIDGE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:Z
Authorized Official - Last Name:DESKURAKIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-864-2003
Mailing Address - Street 1:186 CONCORD AVE
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02138-2318
Mailing Address - Country:US
Mailing Address - Phone:617-864-2003
Mailing Address - Fax:
Practice Address - Street 1:186 CONCORD AVE
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02138-2318
Practice Address - Country:US
Practice Address - Phone:617-864-2003
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-21
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty