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General NPI Number Information
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NPI Number | 1396053542
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Entity Type | Organization
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Legal Business Name | AXIS ORTHODONTICS PC
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Dates
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Enumeration Date | 09/22/2010
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Last Update Date | 09/22/2010
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Provider Practice Location Address
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Address Line | 980 MAIN ST
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City | WALTHAM
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State | MA
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Zip | 02451-7404
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Country | US
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Telephone | 781-899-2340
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Fax |
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Provider Business Mailing Address
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Address Line | 980 MAIN ST
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City | WALTHAM
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State | MA
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Zip | 02451-7404
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Country | US
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Telephone | 781-899-2340
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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. E ELON JOFFRE
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Credential | DMD
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Telephone | 617-320-2587
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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 | DN21568
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License Number State | MA
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