Healthcare Provider Details

I. General information

NPI: 1164457487
Provider Name (Legal Business Name): GOOD IMPRESSIONS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 01/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

463 WORCESTER RD SUITE 404
FRAMINGHAM MA
01701-5356
US

IV. Provider business mailing address

463 WORCESTER RD SUITE 404
FRAMINGHAM MA
01701-5356
US

V. Phone/Fax

Practice location:
  • Phone: 508-872-5555
  • Fax: 508-620-7939
Mailing address:
  • Phone: 508-872-5555
  • Fax: 508-620-7939

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number20255
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number18361
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number16813
License Number StateMA
# 4
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number8868
License Number StateMA
# 5
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number14852
License Number StateMA

VIII. Authorized Official

Name: MEERA OHRI
Title or Position: PRESIDENT
Credential: DMD
Phone: 508-872-5555