Healthcare Provider Details

I. General information

NPI: 1750844080
Provider Name (Legal Business Name): C.M.F.-CRANIO-MAXILLOFACIAL SURGERY ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2019
Last Update Date: 05/22/2025
Certification Date: 05/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

287 MIDDLESEX AVE
MEDFORD MA
02155-5056
US

IV. Provider business mailing address

366 BROADWAY STE 100
SOMERVILLE MA
02145-2812
US

V. Phone/Fax

Practice location:
  • Phone: 617-286-5780
  • Fax:
Mailing address:
  • Phone: 617-628-8000
  • Fax: 617-628-2370

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. TIMOTHY MARX OSBORN
Title or Position: OWNER
Credential: MD, DDS
Phone: 617-628-8000