Healthcare Provider Details

I. General information

NPI: 1003251398
Provider Name (Legal Business Name): BURLINGTON ORAL AND FACIAL SURGERY CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2013
Last Update Date: 02/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

77 S BEDFORD ST SUITE 100
BURLINGTON MA
01803-5115
US

IV. Provider business mailing address

77 SOUTH BEDFORD STREET SUITE 100
BURLINGTON MA
01803
US

V. Phone/Fax

Practice location:
  • Phone: 781-272-0800
  • Fax:
Mailing address:
  • Phone: 781-272-0800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDN1855832
License Number StateMA

VIII. Authorized Official

Name: DR. CHRISTOPHER G PACE
Title or Position: OWNER
Credential: DMD
Phone: 781-272-0800