MEDICARE: DR. ADAM ORDEN DDS, MS

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)	15195	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	X04601	OTHER	MA	BLUE CROSS

General Provider Information

NPI Number	:	1265435028
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ADAM ORDEN DDS, MS

Provider Business Mailing Address
First Line	:	1330 BEACON ST
Second Line	:	STE 344
City	:	BROOKLINE
State	:	MA
Zip	:	02446-3202
Country	:	US
Telephone Number	:	617-277-6700
Fax Number	:	617-232-8931

Provider Business Practice Location Address
First Line	:	1330 BEACON ST
Second Line	:	STE 344
City	:	BROOKLINE
State	:	MA
Zip	:	02446-3202
Country	:	US
Telephone Number	:	617-277-6700
Fax Number	:	617-232-8931

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/24/2005
Last Update Date	:	07/08/2007

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