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General NPI Number Information
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NPI Number | 1649644667
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Entity Type | Organization
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Legal Business Name | CENTRAL MA ORTHODONTIC ASSOCIATES, P.C.
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Dates
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Enumeration Date | 11/16/2015
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Last Update Date | 11/16/2015
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Provider Practice Location Address
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Address Line | 325 SOUTHBRIDGE ST
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City | AUBURN
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State | MA
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Zip | 01501-2595
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Country | US
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Telephone | 508-823-5776
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Fax | 508-832-3066
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Provider Business Mailing Address
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Address Line | 325 SOUTHBRIDGE STREET
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City | AUBURN
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State | MA
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Zip | 01501-2585
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Country | US
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Telephone | 508-823-5776
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Fax | 508-832-3066
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Authorized Official
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Title or Position | ORTHODONTIST, TREASURER, OWNER
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Name | DR. LISA MARIE GIARRUSSO
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Credential | DMD
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Telephone | 508-832-5776
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DN17729
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License Number State | MA
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