Provider Demographics
NPI:1801820824
Name:CONCORD AND LEXINGTON ORAL SURGERY ASSOCIATES, LLC
Entity type:Organization
Organization Name:CONCORD AND LEXINGTON ORAL SURGERY ASSOCIATES, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:T
Authorized Official - Last Name:CALDWELL
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, MD
Authorized Official - Phone:781-861-8855
Mailing Address - Street 1:150 BAKER AVENUE EXT STE 101
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:MA
Mailing Address - Zip Code:01742-2199
Mailing Address - Country:US
Mailing Address - Phone:978-369-2525
Mailing Address - Fax:978-369-7425
Practice Address - Street 1:150 BAKER AVENUE EXT STE 101
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:MA
Practice Address - Zip Code:01742-2199
Practice Address - Country:US
Practice Address - Phone:978-369-2525
Practice Address - Fax:978-369-7425
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2024-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA19992174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA19992OtherSTATE LICENSE
MAX08668OtherBLUE CROSS BLUE SHIELD
MA019992OtherTUFTS HEALTH PLAN
MA16643OtherHARVARD PILGRIM
MAX20094Medicare ID - Type Unspecified
MA19992OtherSTATE LICENSE