Provider Demographics
NPI:1538426465
Name:MSL FACIAL & ORAL SURGERY
Entity type:Organization
Organization Name:MSL FACIAL & ORAL SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:CATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:ALMONTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:401-739-5500
Mailing Address - Street 1:17 N WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:NORTH ATTLEBORO
Mailing Address - State:MA
Mailing Address - Zip Code:02760-1605
Mailing Address - Country:US
Mailing Address - Phone:508-699-9499
Mailing Address - Fax:508-699-4217
Practice Address - Street 1:17 N WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:NORTH ATTLEBORO
Practice Address - State:MA
Practice Address - Zip Code:02760-1605
Practice Address - Country:US
Practice Address - Phone:508-699-9499
Practice Address - Fax:508-699-4217
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-17
Last Update Date:2012-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA206161223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIU84968Medicare UPIN