Provider Demographics
NPI:1831602382
Name:MELROSE ORTHODONTICS, PC
Entity type:Organization
Organization Name:MELROSE ORTHODONTICS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MOIRA
Authorized Official - Middle Name:
Authorized Official - Last Name:CASEY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:781-665-1355
Mailing Address - Street 1:540 LYNN FELLS PKWY
Mailing Address - Street 2:
Mailing Address - City:MELROSE
Mailing Address - State:MA
Mailing Address - Zip Code:02176-2327
Mailing Address - Country:US
Mailing Address - Phone:781-665-1355
Mailing Address - Fax:
Practice Address - Street 1:540 LYNN FELLS PKWY
Practice Address - Street 2:
Practice Address - City:MELROSE
Practice Address - State:MA
Practice Address - Zip Code:02176-2327
Practice Address - Country:US
Practice Address - Phone:781-665-1355
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-07
Last Update Date:2017-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN18561821223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty