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General NPI Number Information
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NPI Number | 1184850091
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Entity Type | Organization
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Legal Business Name | CENTRAL MA ORTHODONITC ASSOCIATES, PC
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Dates
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Enumeration Date | 06/05/2009
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Last Update Date | 06/05/2009
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Provider Practice Location Address
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Address Line | 276 MAIN ST
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City | SPENCER
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State | MA
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Zip | 01562-1838
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Country | US
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Telephone | 508-885-2749
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Fax | 508-885-0907
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Provider Business Mailing Address
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Address Line | 276 MAIN ST
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City | SPENCER
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State | MA
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Zip | 01562-1838
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Country | US
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Telephone | 508-885-2749
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Fax | 508-885-0907
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Authorized Official
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Title or Position | PRESIDENT,TREASURER CMOA, PC
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Name | LISA MARIE GIARRUSSO
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Credential | D.M.D.
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Telephone | 508-753-2489
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 17729
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License Number State | MA
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