MEDFORD ENDODONTICS, LLC (NPI# 1780974477) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1780974477 |
| Entity Type | Organization |
| Organization Name | MEDFORD ENDODONTICS, LLC |
| Practice Address |
Zero Governors Avenue, Suite 30 Medford MA 02155-3006 |
| Mailing Address |
Zero Governors Avenue., Suite 30 Medford MA 02155-0000 |
| Practice Telephone | 7813915100 |
| Practice Fax Number | 7813914833 |
| Mailing Telephone | 7813915100 |
| Enumeration Date | 2011-04-14 |
| Last Update Date | 2011-04-14 |
| Authorized Official Name | DR. MARK G WANG (PRESIDENT) |
| Authorized Official Telephone | 7813915100 |
| Authorized Official Credential | D.M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223E0200X |
Dentist Specialization: Endodontics |
20514 | MA | Dental Providers |
| Street Address |
ZERO GOVERNORS AVENUE, SUITE 30 |
| City | MEDFORD |
| State | MA |
| Zip Code | 02155-3006 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679113922 | Elena Chapman | Nurse Practitioner | 293 Salem St 4, Medford, MA 02155 | 2020-01-14 |
| 1922658830 | Michelle Anne Zona | Counselor | 100 George Hassett Dr, Medford, MA 02155 | 2019-09-13 |
| 1487138509 | Dava Davainis | Social Worker | 76 Newbern Avenue, Apt. 1, Medford, MA 02155 | 2018-09-25 |
| 1265915128 | Erin Roberts | Counselor | Medford Public Schools, 3002 Mystic Valley Pkwy, Medford, MA 02155 | 2018-09-07 |
| 1871075739 | Janice Madeline Cole | Social Worker | 3820 Mystic Valley Pkwy Unit 805, Medford, MA 02155 | 2018-09-06 |
| 1447732573 | Mystick Women's Health, Inc. | Obstetrics & Gynecology | 13 Bradlee Road, Medford, MA 02155 | 2018-09-05 |
| 1144713090 | Laura Rogers | Psychologist | 203 Paige Hall, 12 Upper Campus Road, Medford, MA 02155 | 2018-06-14 |
| 1871086694 | Shuo Yang | Dentist | 8 9th St Apt 310, Medford, MA 02155 | 2018-06-07 |
| 1891287108 | Xuhua Qin | Psychologist | 120 Curtis Street, Medford, MA 02155 | 2018-06-01 |
| 1568953529 | Cvs Pharmacy, Inc. | Durable Medical Equipment & Medical Supplies | 471 Salem St, Medford, MA 02155 | 2018-05-25 |
| Find all providers in zip 02155 | ||||
| Taxonomy Code | 1223E0200X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Endodontics |
| The branch of dentistry that is concerned with the morphology, physiology and pathology of the human dental pulp and periradicular tissues. Its study and practice encompass the basic and clinical sciences including biology of the normal pulp, the etiology, diagnosis, prevention and treatment of diseases and injuries of the pulp and associated periradicular conditions. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609121599 | Marc A Rasmussen | Dentist | 2924 Siskiyou Blvd Ste 204, Medford, OR 97504-8197 | 2012-07-17 |
| 1700197134 | Erik Brian Gonzalez | Dentist | 21 Scotch Pine Dr, Medford, NY 11763-4220 | 2010-06-30 |
| 1629300272 | Henry Lucien Harbert | Dentist | 691 Murphy Rd., Ste 204, Medford, OR 97504 | 2010-02-08 |
| 1043470479 | Matt Gebhardt | Dentist | 831 Alder Creek Dr, Medford, OR 97504-8900 | 2008-06-10 |
| 1073789582 | Marlene Imelda Oviedo-marmo | Dentist | 30 Jackson Rd Ste C2, Medford, NJ 08055-9281 | 2008-05-05 |
| 1932197019 | Gerald B. Leiber | Dentist | 0 Governors Ave, Suite 30, Medford, MA 02155-3025 | 2005-10-12 |
| 1194722892 | Michael Curtis Hall | Dentist | 2952 Lazy Creek Dr, Medford, OR 97504-8182 | 2005-07-07 |
| 1396983169 | Cary James Cunningham | Dentist | 2924 Siskiyou Blvd, Suite 204, Medford, OR 97504-8194 | 2009-01-31 |
| 1548436009 | Carl Lewis Tinkelman | Dentist | 30 Jackson Rd, Suite C-2, Medford, NJ 08055-9283 | 2008-05-05 |
| 1528272721 | Gerald B. Leiber, D.m.d., P.C. | Dentist | 0 Governors Ave, Suite 30, Medford, MA 02155-3025 | 2007-05-09 |
| Find all providers in MEDFORD | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.