1083759922 NPI number — JOSEPH P NORE DDS INC

Table of content: (NPI 1083759922)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083759922 NPI number — JOSEPH P NORE DDS INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JOSEPH P NORE DDS INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1083759922
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/30/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 320225
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WEST ROXBURY
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02132
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
586 TREMONT ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BOSTON
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02118
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
617-267-3334
Provider Business Practice Location Address Fax Number:
617-450-0656
Provider Enumeration Date:
02/20/2007

Additional Information

Authorized Official

Authorized Official Last Name:
NORE
Authorized Official First Name:
JOSEPH
Authorized Official Middle Name:
P
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
617-267-3334

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  14035 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1992716468 . This is a "INDIVIDUAL NPI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 9786147 . This is a "MASS HEALTH GP NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0252832 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: X11952 . This is a "BCBS MA" identifier . This identifiers is of the category "OTHER".




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