| Melrose Wakefield Oral Surgery Inc. | |
|
810 Main St Melrose MA 02176-2711 | |
| (781) 662-6228 | |
| (781) 662-4455 |
| Full Name | Melrose Wakefield Oral Surgery Inc. |
|---|---|
| Speciality | Dentist |
| Location | 810 Main St, Melrose, Massachusetts |
| Authorized Official Name and Position | Janet Nightingale (MANAGER) |
| Authorized Official Contact | 7816626228 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Melrose Wakefield Oral Surgery Inc. 810 Main St Melrose MA 02176-2711 Ph: (781) 662-6228 | Melrose Wakefield Oral Surgery Inc. 810 Main St Melrose MA 02176-2711 Ph: (781) 662-6228 |
| NPI Number | 1568409902 |
|---|---|
| Provider Enumeration Date | 06/02/2006 |
| Last Update Date | 04/01/2015 |
| Medicare PECOS PAC ID | 0244249209 |
|---|---|
| Medicare Enrollment ID | O20060419000533 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1568409902 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223S0112X | Dentist - Oral And Maxillofacial Surgery | (* (Not Available)) | Primary |
| Provider Name | Bart F Blaeser |
|---|---|
| Provider Type | Practitioner - Maxillofacial Surgery |
| Provider Identifiers | NPI Number: 1477544609 PECOS PAC ID: 9133138191 Enrollment ID: I20060427000350 |
| Provider Name | Melissa M Lackey |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1386635514 PECOS PAC ID: 1052320017 Enrollment ID: I20060913000162 |
| Provider Name | Jose M Marchena |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1710962931 PECOS PAC ID: 7315946159 Enrollment ID: I20061205000543 |
| Provider Name | Mary E E Dipirro |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1437350675 PECOS PAC ID: 9638351810 Enrollment ID: I20110309000332 |
| Provider Name | Paul E Gordon |
|---|---|
| Provider Type | Practitioner - Maxillofacial Surgery |
| Provider Identifiers | NPI Number: 1164448171 PECOS PAC ID: 6608054192 Enrollment ID: I20110706000020 |
| Provider Name | Ilya L Garibyan |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1588079370 PECOS PAC ID: 8820326937 Enrollment ID: I20190828001408 |
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