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General NPI Number Information
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NPI Number | 1457375107
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Entity Type | Organization
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Legal Business Name | COMMONWEALTH ORAL & MAXILLOFACIAL SURGICAL ASSOCIATES INC.
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Dates
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Enumeration Date | 07/26/2006
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Last Update Date | 11/04/2008
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Provider Practice Location Address
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Address Line | 2353 MASSACHUSETTS AVE
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City | CAMBRIDGE
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State | MA
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Zip | 02140-1252
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Country | US
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Telephone | 617-492-8700
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Fax | 617-492-0698
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Provider Business Mailing Address
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Address Line | 2353 MASSACHUSETTS AVE
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City | CAMBRIDGE
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State | MA
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Zip | 02140-1252
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Country | US
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Telephone | 617-492-8700
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Fax | 617-492-0698
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. EDWARD L LECHTENBERG
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Credential | DMD
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Telephone | 617-492-8700
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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 | 15441
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 20462
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License Number State | MA
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Taxonomy #3
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 10823
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License Number State | MA
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