MEDICARE: GOOD IMPRESSIONS INC

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
1	122300000X	Dentist	20255	MA
2	1223E0200X	Endodontics	18361	MA
3	1223P0300X	Periodontics	16813	MA
4	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	8868	MA
5	122300000X	Dentist	14852	MA

General Provider Information

NPI Number	:	1164457487
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GOOD IMPRESSIONS INC

Provider Business Mailing Address
First Line	:	463 WORCESTER RD
Second Line	:	SUITE 404
City	:	FRAMINGHAM
State	:	MA
Zip	:	01701-5356
Country	:	US
Telephone Number	:	508-872-5555
Fax Number	:	508-620-7939

Provider Business Practice Location Address
First Line	:	463 WORCESTER RD
Second Line	:	SUITE 404
City	:	FRAMINGHAM
State	:	MA
Zip	:	01701-5356
Country	:	US
Telephone Number	:	508-872-5555
Fax Number	:	508-620-7939

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MEERA OHRI
Credential	:	DMD
Telephone Number	:	508-872-5555

Provider Enumeration Date	:	07/12/2006
Last Update Date	:	01/24/2011

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Directions to “GOOD IMPRESSIONS INC ” Practice Location

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