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General NPI Number Information
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NPI Number | 1386107118
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Entity Type | Organization
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Legal Business Name | PEABODY DANVERS ORAL SURGERY, PLLC
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Dates
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Enumeration Date | 04/09/2019
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Last Update Date | 04/09/2019
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Provider Practice Location Address
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Address Line | 80 LINDALL ST STE 8
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City | DANVERS
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State | MA
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Zip | 01923-2135
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Country | US
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Telephone | 978-777-0505
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Fax | 978-750-4029
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Provider Business Mailing Address
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Address Line | 33 TRAFALGAR SQ STE 201
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City | NASHUA
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State | NH
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Zip | 03063-4901
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Country | US
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Telephone | 603-595-8889
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Fax | 603-595-2027
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Authorized Official
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Title or Position | BILLING COORDINATOR
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Name | JO A GOY
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Credential |
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Telephone | 603-595-8889
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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 |
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License Number State |
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