MEDICARE: ORAL SURGERY ASSOCIATES SOUTHCOAST, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	15595	MA

General Provider Information

NPI Number	:	1043255383
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ORAL SURGERY ASSOCIATES SOUTHCOAST, INC.

Provider Business Mailing Address
First Line	:	81 HAWTHORN ST
Second Line	:
City	:	NEW BEDFORD
State	:	MA
Zip	:	02740-3429
Country	:	US
Telephone Number	:	508-992-3737
Fax Number	:	508-993-3798

Provider Business Practice Location Address
First Line	:	81 HAWTHORN ST
Second Line	:
City	:	NEW BEDFORD
State	:	MA
Zip	:	02740-3429
Country	:	US
Telephone Number	:	508-992-3737
Fax Number	:	508-993-3798

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. PATRICK J FARREN
Credential	:	D.M.D.
Telephone Number	:	508-992-3737

Provider Enumeration Date	:	06/19/2006
Last Update Date	:	03/26/2009

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