Healthcare Provider Details

I. General information

NPI: 1689772477
Provider Name (Legal Business Name): LOWELL ORAL SURGERY ASSOCIATES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 08/27/2025
Certification Date: 08/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33 BARTLETT ST SUITE 405
LOWELL MA
01852-1334
US

IV. Provider business mailing address

33 BARTLETT ST SUITE 405
LOWELL MA
01852-1334
US

V. Phone/Fax

Practice location:
  • Phone: 978-458-1264
  • Fax:
Mailing address:
  • Phone: 978-458-1264
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0106X
TaxonomyOral and Maxillofacial Pathology Dentistry
License Number
License Number State

VIII. Authorized Official

Name: PATRICIA L YOUNG
Title or Position: CEO
Credential: MBA, FACMPE
Phone: 978-458-1264