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General NPI Number Information
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NPI Number | 1760863468
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Entity Type | Organization
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Legal Business Name | THE BRACES PLACE OF LAWRENCE
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Dates
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Enumeration Date | 06/18/2015
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Last Update Date | 06/18/2015
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Provider Practice Location Address
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Address Line | 509 CONCORD ST
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City | FRAMINGHAM
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State | MA
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Zip | 01702-2319
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Country | US
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Telephone | 508-879-4400
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Fax |
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Provider Business Mailing Address
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Address Line | 30 COLLEGE AVE
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City | SOMERVILLE
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State | MA
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Zip | 02144-1914
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CORPORATE MANAGER
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Name | MRS. JULIANA MASIELLO
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Credential |
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Telephone | 617-591-9999
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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 | DN20416
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License Number State | MA
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