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General NPI Number Information
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NPI Number | 1720245228
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Entity Type | Organization
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Legal Business Name | NELSON AND HERTZBERG ORTHODONTICS OF CAMBRIDGE LLC
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Dates
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Enumeration Date | 05/21/2008
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Last Update Date | 05/21/2008
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Provider Practice Location Address
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Address Line | 186 CONCORD AVE
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City | CAMBRIDGE
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State | MA
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Zip | 02138-2318
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Country | US
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Telephone | 617-864-2003
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Fax |
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Provider Business Mailing Address
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Address Line | 186 CONCORD AVE
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City | CAMBRIDGE
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State | MA
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Zip | 02138-2318
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Country | US
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Telephone | 617-864-2003
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Fax |
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. JACQUELINE Z DESKURAKIS
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Credential |
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Telephone | 617-864-2003
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number |
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License Number State |
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