Healthcare Provider Details

I. General information

NPI: 1508096496
Provider Name (Legal Business Name): LYNN ORAL SURGERY ASSOCIATES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2009
Last Update Date: 04/13/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

85 EXCHANGE ST STE 102
LYNN MA
01901-1429
US

IV. Provider business mailing address

85 EXCHANGE ST STE 102
LYNN MA
01901-1429
US

V. Phone/Fax

Practice location:
  • Phone: 781-592-0222
  • Fax: 781-592-0750
Mailing address:
  • Phone: 781-592-0222
  • Fax: 781-592-0750

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: GEORGE HATZIGIANNIS
Title or Position: PARTNER
Credential: DMD,MD
Phone: 978-531-1450