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General NPI Number Information
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NPI Number | 1649279118
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Entity Type | Organization
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Legal Business Name | MIDDLESEX ORAL SURGERY GROUP
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Dates
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Enumeration Date | 07/18/2005
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 126 UNION ST
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City | MARLBORO
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State | MA
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Zip | 01752-1207
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Country | US
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Telephone | 508-485-3245
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Fax | 508-485-5957
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Provider Business Mailing Address
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Address Line | 126 UNION ST
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City | MARLBORO
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State | MA
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Zip | 01752-1207
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Country | US
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Telephone | 508-485-3245
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Fax | 508-485-5957
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Authorized Official
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Title or Position | PRESIDENT
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Name | JEROME D ANDERSON
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Credential | DDS
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Telephone | 508-485-3245
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 204E00000X
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Taxonomy Name | Oral & Maxillofacial Surgery (D.M.D.)
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License Number |
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License Number State | MA
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