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General NPI Number Information
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NPI Number | 1114362738
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Entity Type | Organization
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Legal Business Name | WILBRAHAM ORTHODONTICS PC
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Dates
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Enumeration Date | 05/09/2013
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Last Update Date | 05/09/2013
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Provider Practice Location Address
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Address Line | 3 CRANE PARK DR
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City | WILBRAHAM
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State | MA
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Zip | 01095-1787
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Country | US
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Telephone | 413-596-9657
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Fax |
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Provider Business Mailing Address
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Address Line | 3 CRANE PARK DR
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City | WILBRAHAM
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State | MA
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Zip | 01095-1787
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Country | US
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Telephone | 413-596-9657
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MICHAEL MARGOLIS
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Credential | DDS, PHD
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Telephone | 413-596-9657
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 19247
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License Number State | MA
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