Healthcare Provider Details

I. General information

NPI: 1427454388
Provider Name (Legal Business Name): MEOLA & ASSOCIATES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/05/2014
Last Update Date: 11/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

76 BEDFORD ST UNIT 9
LEXINGTON MA
02420-4646
US

IV. Provider business mailing address

76 BEDFORD ST UNIT 9
LEXINGTON MA
02420-4646
US

V. Phone/Fax

Practice location:
  • Phone: 781-860-0115
  • Fax: 781-860-5144
Mailing address:
  • Phone: 781-860-0115
  • Fax: 781-860-5144

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN1856618
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code1223E0200X
TaxonomyEndodontics
License NumberDN21623
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number21707
License Number StateMA
# 4
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number20998
License Number StateMA
# 5
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number17511
License Number StateMA

VIII. Authorized Official

Name: DR. DAMIAN MEOLA
Title or Position: OWNER
Credential:
Phone: 781-860-0115