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General NPI Number Information
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NPI Number | 1467427567
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Entity Type | Organization
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Legal Business Name | MEDFORD ORAL SURGERY ASSOCIATES, INC.
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Dates
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Enumeration Date | 02/22/2006
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Last Update Date | 04/07/2009
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Provider Practice Location Address
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Address Line | 689 FELLSWAY
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City | MEDFORD
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State | MH
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Zip | 02155
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Country | US
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Telephone | 781-395-3100
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Fax | 781-395-3058
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Provider Business Mailing Address
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Address Line | 689 FELLSWAY
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City | MEDFORD
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State | MA
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Zip | 02155-4931
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Country | US
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Telephone | 781-395-3100
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Fax | 781-395-3058
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. LAWRENCE WILLIAM JOYCE
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Credential | DMD
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Telephone | 781-395-3100
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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 | 13669
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License Number State | MA
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