Provider Demographics
NPI:1972949279
Name:WEYMOUTH ORAL AND MAXILLOFACIAL SURGERY, PC
Entity type:Organization
Organization Name:WEYMOUTH ORAL AND MAXILLOFACIAL SURGERY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:JUVET
Authorized Official - Suffix:
Authorized Official - Credentials:DDS MD
Authorized Official - Phone:781-331-2422
Mailing Address - Street 1:851 MAIN ST
Mailing Address - Street 2:SUITE #20
Mailing Address - City:WEYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02190-1612
Mailing Address - Country:US
Mailing Address - Phone:781-331-2422
Mailing Address - Fax:781-331-2780
Practice Address - Street 1:851 MAIN ST
Practice Address - Street 2:SUITE #20
Practice Address - City:WEYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02190-1612
Practice Address - Country:US
Practice Address - Phone:781-331-2422
Practice Address - Fax:781-331-2780
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-14
Last Update Date:2013-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA20468261QS0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0112XAmbulatory Health Care FacilitiesClinic/CenterOral and Maxillofacial Surgery