MEDICARE: ENDODONTIC ASSOCIATES, 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	1223E0200X	Endodontics	18324	MA

General Provider Information

NPI Number	:	1104949361
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ENDODONTIC ASSOCIATES, INC.

Provider Business Mailing Address
First Line	:	201 BOSTON POST RD W
Second Line	:	SUITE 409
City	:	MARLBOROUGH
State	:	MA
Zip	:	01752-4667
Country	:	US
Telephone Number	:	508-485-6723
Fax Number	:	508-229-8544

Provider Business Practice Location Address
First Line	:	201 BOSTON POST RD W
Second Line	:	SUITE 409
City	:	MARLBOROUGH
State	:	MA
Zip	:	01752-4667
Country	:	US
Telephone Number	:	508-485-6723
Fax Number	:	508-229-8544

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. MARTA ORREGO RAFLA
Credential	:	D.M.D
Telephone Number	:	508-485-6723

Provider Enumeration Date	:	04/10/2007
Last Update Date	:	08/22/2020

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