Healthcare Provider Details

I. General information

NPI: 1396950762
Provider Name (Legal Business Name): ORTHODONTIC PARTNERS LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1109 PUTNAM PIKE
CHEPACHET RI
02814
US

IV. Provider business mailing address

15 OAK KNOLL DR
NORTH ATTLEBORO MA
02760-6203
US

V. Phone/Fax

Practice location:
  • Phone: 140-156-8118
  • Fax:
Mailing address:
  • Phone: 508-761-5230
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number16514
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number2220
License Number StateRI

VIII. Authorized Official

Name: DR. RAYMOND GEORGE JR.
Title or Position: PRESIDENT
Credential: D.M.D.
Phone: 508-761-5230