Healthcare Provider Details

I. General information

NPI: 1629308184
Provider Name (Legal Business Name): ARCH ORTHODONTICS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/06/2010
Last Update Date: 01/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 WALNUT AVE
STOUGHTON MA
02072-2982
US

IV. Provider business mailing address

5 WALNUT AVE
STOUGHTON MA
02072-2982
US

V. Phone/Fax

Practice location:
  • Phone: 781-344-1150
  • Fax:
Mailing address:
  • Phone: 781-344-1150
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number11813
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number20189
License Number StateMA
# 3
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number11954
License Number StateMA

VIII. Authorized Official

Name: LUCILIA COBB
Title or Position: OFFICE MANAGER
Credential:
Phone: 781-344-1150