MEDICARE: NEDG - CHELMSFORD 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
1	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1841917911
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEDG - CHELMSFORD LLC

Provider Business Mailing Address
First Line	:	257 TURNPIKE RD STE 110
Second Line	:
City	:	SOUTHBOROUGH
State	:	MA
Zip	:	01772-1791
Country	:	US
Telephone Number	:	508-281-6464
Fax Number	:

Provider Business Practice Location Address
First Line	:	290 LITTLETON RD
Second Line	:
City	:	CHELMSFORD
State	:	MA
Zip	:	01824-3406
Country	:	US
Telephone Number	:	978-256-3261
Fax Number	:

Authorized Official
Title or Position	:	CLINICAL SYSTEMS DIRECTOR
Name	:	ALICIA LACLAIR
Credential	:
Telephone Number	:	508-281-6464

Provider Enumeration Date	:	10/20/2022
Last Update Date	:	10/20/2022

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