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General NPI Number Information
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NPI Number | 1619015567
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Entity Type | Organization
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Legal Business Name | MERRIMACK VALLEY DENTISTRY P.C.
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Dates
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Enumeration Date | 02/02/2007
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Last Update Date | 11/20/2014
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Provider Practice Location Address
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Address Line | 144 ARLINGTON STREET
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City | DRACUT
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State | MA
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Zip | 01826
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Country | US
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Telephone | 978-957-1898
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Fax | 978-957-6262
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Provider Business Mailing Address
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Address Line | 144 ARLINGTON STREET
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City | DRACUT
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State | MA
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Zip | 01826
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Country | US
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Telephone | 978-957-1898
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Fax | 978-957-6262
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. JASON PETER PUJO
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Credential | D.M.D.
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Telephone | 978-957-1898
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 19374
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License Number State | MA
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