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General NPI Number Information
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NPI Number | 1801820824
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Entity Type | Organization
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Legal Business Name | CONCORD AND LEXINGTON ORAL SURGERY ASSOCIATES, LLC
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Dates
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Enumeration Date | 07/10/2006
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Last Update Date | 10/28/2024
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Provider Practice Location Address
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Address Line | 150 BAKER AVENUE EXT STE 101
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City | CONCORD
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State | MA
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Zip | 01742-2199
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Country | US
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Telephone | 978-369-2525
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Fax | 978-369-7425
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Provider Business Mailing Address
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Address Line | 150 BAKER AVENUE EXT STE 101
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City | CONCORD
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State | MA
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Zip | 01742-2199
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Country | US
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Telephone | 978-369-2525
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Fax | 978-369-7425
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Authorized Official
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Title or Position | PARTNER
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Name | DR. GREGORY T. CALDWELL
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Credential | DMD, MD
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Telephone | 781-861-8855
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 19992
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License Number State | MA
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