Healthcare Provider Details

I. General information

NPI: 1831602382
Provider Name (Legal Business Name): MELROSE ORTHODONTICS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2017
Last Update Date: 11/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

540 LYNN FELLS PKWY
MELROSE MA
02176-2327
US

IV. Provider business mailing address

540 LYNN FELLS PKWY
MELROSE MA
02176-2327
US

V. Phone/Fax

Practice location:
  • Phone: 781-665-1355
  • Fax:
Mailing address:
  • Phone: 781-665-1355
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberDN1856182
License Number StateMA

VIII. Authorized Official

Name: DR. MOIRA CASEY
Title or Position: OWNER
Credential: DMD
Phone: 781-665-1355