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General NPI Number Information
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NPI Number | 1881308310
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Entity Type | Organization
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Legal Business Name | LOWELL DENTISTRY AND BRACES, PC
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Dates
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Enumeration Date | 01/10/2023
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Last Update Date | 01/10/2023
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Provider Practice Location Address
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Address Line | 1201 BRIDGE ST
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City | LOWELL
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State | MA
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Zip | 01850-1293
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Country | US
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Telephone | 978-455-7056
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Fax |
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Provider Business Mailing Address
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Address Line | 5 MOUNT ROYAL AVE STE 300
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City | MARLBOROUGH
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State | MA
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Zip | 01752-1900
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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 | CFO
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Name | JOANNE TAVANO
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Credential |
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Telephone | 508-872-3072
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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 |
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License Number State |
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