Healthcare Provider Details

I. General information

NPI: 1487826418
Provider Name (Legal Business Name): COMMONWEALTH ORAL & MAXILLOFACIAL SURGICAL ASSOCIATES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/31/2008
Last Update Date: 03/31/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

251 MASSACHUSETTS AVE
ARLINGTON MA
02474-8406
US

IV. Provider business mailing address

251 MASSACHUSETTS AVE
ARLINGTON MA
02474-8406
US

V. Phone/Fax

Practice location:
  • Phone: 781-648-3400
  • Fax:
Mailing address:
  • Phone: 781-648-3400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number15441
License Number StateMA

VIII. Authorized Official

Name: DR. CLAUDE L FONTAINE
Title or Position: PARTNER
Credential: DMD
Phone: 781-648-3400