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General NPI Number Information
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NPI Number | 1376760413
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Entity Type | Organization
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Legal Business Name | NEPONSET VALLEY ORAL AND MAXILLOFACIAL SURGERY ASSOCIATES, PLLC
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Dates
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Enumeration Date | 04/19/2007
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Last Update Date | 09/28/2021
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Provider Practice Location Address
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Address Line | 841 MAIN ST
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City | WALPOLE
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State | MA
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Zip | 02081-2997
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Country | US
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Telephone | 508-660-2900
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Fax | 508-660-0134
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Provider Business Mailing Address
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Address Line | 841 MAIN STREET
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City | WALPOLE
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State | MA
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Zip | 02081-2997
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Country | US
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Telephone | 508-660-2900
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Fax | 508-660-0134
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Authorized Official
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Title or Position | PRESIDENT
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Name | LAWRENCE T HERMAN
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Credential | DMD, MD
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Telephone | 508-660-2900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 12548
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License Number State | MA
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