Healthcare Provider Details

I. General information

NPI: 1902937493
Provider Name (Legal Business Name): THOMAS GEORGE BJORNSON DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/08/2007
Last Update Date: 02/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 LINCOLN RD SUITE 104
LINCOLN MA
01773-3834
US

IV. Provider business mailing address

PO BOX 53
LINCOLN MA
01773-0053
US

V. Phone/Fax

Practice location:
  • Phone: 781-257-5216
  • Fax: 781-257-5077
Mailing address:
  • Phone: 781-257-5216
  • Fax: 781-257-5077

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number20627
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: