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General NPI Number Information
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NPI Number | 1699223891
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Entity Type | Organization
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Legal Business Name | STOW ORTHODONTICS
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Dates
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Enumeration Date | 09/15/2016
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Last Update Date | 09/15/2016
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Provider Practice Location Address
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Address Line | 117 GREAT RD #16
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City | STOW
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State | MA
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Zip | 01775-1191
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Country | US
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Telephone | 978-637-2952
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Fax |
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Provider Business Mailing Address
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Address Line | 117 GREAT RD #16
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City | STOW
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State | MA
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Zip | 01775-1191
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Country | US
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Telephone | 978-637-2952
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Fax |
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Authorized Official
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Title or Position | ORTHODONTIST
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Name | DR. CAROLYN LUCEY
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Credential | D.M.D., M.D.S
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Telephone | 978-637-2952
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | DN21591
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License Number State | MA
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