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General NPI Number Information
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NPI Number | 1902074073
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Entity Type | Organization
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Legal Business Name | MARLBOROUGH ORAL & MAXILLOFACIAL SURGERY, PC
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Dates
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Enumeration Date | 02/12/2008
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Last Update Date | 09/04/2020
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Provider Practice Location Address
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Address Line | 431 LAKESIDE AVE
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City | MARLBOROUGH
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State | MA
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Zip | 01752-1979
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Country | US
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Telephone | 508-485-5575
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Fax |
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Provider Business Mailing Address
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Address Line | 431 LAKESIDE AVE
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City | MARLBOROUGH
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State | MA
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Zip | 01752-1979
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Country | US
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Telephone | 508-485-5575
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. EUGER LIN
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Credential | DMD, FRCD(C)
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Telephone | 508-485-5575
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 21555
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License Number State | MA
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