MEDICARE: MS ORTHODONTICS ASSOCIATES LLC

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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	21077	MA

General Provider Information

NPI Number	:	1346410024
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MS ORTHODONTICS ASSOCIATES LLC

Provider Business Mailing Address
First Line	:	106 MOUNT AUBURN ST
Second Line	:	SUITE 1A
City	:	WATERTOWN
State	:	MA
Zip	:	02472-3968
Country	:	US
Telephone Number	:	617-926-9500
Fax Number	:

Provider Business Practice Location Address
First Line	:	106 MOUNT AUBURN ST
Second Line	:	SUITE 1A
City	:	WATERTOWN
State	:	MA
Zip	:	02472-3968
Country	:	US
Telephone Number	:	617-926-9500
Fax Number	:

Authorized Official
Title or Position	:	MEMBER
Name	:	DR. ANNA K SIMON
Credential	:	D.M.D.
Telephone Number	:	617-926-9500

Provider Enumeration Date	:	03/10/2008
Last Update Date	:	07/11/2008

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