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General NPI Number Information
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NPI Number | 1881982411
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Entity Type | Organization
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Legal Business Name | LAKEWOOD PARK ORTHODONTICS
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Dates
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Enumeration Date | 07/18/2011
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Last Update Date | 07/18/2011
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Provider Practice Location Address
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Address Line | 214 N MAIN ST STE 209
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City | NATICK
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State | MA
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Zip | 01760-1131
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Country | US
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Telephone | 774-270-5429
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Fax |
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Provider Business Mailing Address
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Address Line | 29 ELIOT HILL RD
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City | NATICK
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State | MA
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Zip | 01760-5546
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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 | ORTHODONTIST/OWNER
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Name | JANEEN HUGHES
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Credential | DMD, MED
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Telephone | 774-270-5429
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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 | DN1855316
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License Number State | MA
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