MEDICARE: NORTHEAST ORTHODONTIC SPECIALISTS

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1407095540
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTHEAST ORTHODONTIC SPECIALISTS

Provider Business Mailing Address
First Line	:	8 CREPEAU BLVD
Second Line	:
City	:	CUMBERLAND
State	:	RI
Zip	:	02864-2107
Country	:	US
Telephone Number	:	401-658-1116
Fax Number	:	401-658-1117

Provider Business Practice Location Address
First Line	:	8 CREPEAU BLVD
Second Line	:
City	:	CUMBERLAND
State	:	RI
Zip	:	02864-2107
Country	:	US
Telephone Number	:	401-658-1116
Fax Number	:	401-658-1117

Authorized Official
Title or Position	:	ORTHODONTIST
Name	:	DR. MATTHEW A ALMEIDA
Credential	:	DMD
Telephone Number	:	401-658-1116

Provider Enumeration Date	:	02/12/2009
Last Update Date	:	02/12/2009

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