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NPI Code Detail

MEDICARE: ELIZABETH BLAKE ORTHODONTICS LLC

MEDICARE: ELIZABETH BLAKE ORTHODONTICS LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223X0400XOrthodontics and Dentofacial Orthopedics DentistryDN1855332MA

General Provider Information

NPI Number : 1013253061
Entity Type Code : Organization
Provider Name (Legal Business Name) : ELIZABETH BLAKE ORTHODONTICS LLC
Provider Business Mailing Address
First Line : 2 SILVA ST
Second Line :
City : MILFORD
State : MA
Zip : 01757-3476
Country : US
Telephone Number : 352-262-9532
Fax Number :
Provider Business Practice Location Address
First Line : 77 MAIN ST
Second Line :
City : HOPKINTON
State : MA
Zip : 01748-3118
Country : US
Telephone Number : 352-262-9532
Fax Number :
Authorized Official
Title or Position : ORTHODONTIST
Name : DR. ELIZABETH BLAKE PELUSO
Credential : DMD, MDS
Telephone Number : 352-262-9532
Provider Enumeration Date : 12/19/2012
Last Update Date : 12/19/2012

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Directions to “ELIZABETH BLAKE ORTHODONTICS LLC ” Practice Location

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