Healthcare Provider Details

I. General information

NPI: 1124199914
Provider Name (Legal Business Name): METROWEST ORAL SURGICAL ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

113 WATER ST
MILFORD MA
01757-3021
US

IV. Provider business mailing address

113 WATER ST
MILFORD MA
01757-3021
US

V. Phone/Fax

Practice location:
  • Phone: 508-473-7900
  • Fax: 508-473-7914
Mailing address:
  • Phone: 508-473-7900
  • Fax: 508-473-7914

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number17118
License Number StateMA

VIII. Authorized Official

Name: MRS. MAUREEN O'MALLEY
Title or Position: OFFICE MANAGER
Credential:
Phone: 508-473-7900