| Mystic Valley Orthodontics | |
|
80 High St Suite 2 Medford MA 02155-3872 | |
| (781) 396-9230 | |
| (781) 391-6090 |
| Full Name | Mystic Valley Orthodontics |
|---|---|
| Speciality | Dentist - Orthodontics And Dentofacial Orthopedics |
| Location | 80 High St, Medford, Massachusetts |
| Authorized Official Name and Position | Joy Elizabeth Kasparian-federico (NA) |
| Authorized Official Contact | 7813969230 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Mystic Valley Orthodontics 80 High St Suite 2 Medford MA 02155-3872 Ph: () - | Mystic Valley Orthodontics 80 High St Suite 2 Medford MA 02155-3872 Ph: (781) 396-9230 |
| NPI Number | 1679744668 |
|---|---|
| Provider Enumeration Date | 03/18/2008 |
| Last Update Date | 03/18/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1679744668 | NPI | - | NPPES |
| 0207021 | Medicaid | MA | |
| 0209104 | Medicaid | MA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223X0400X | Dentist - Orthodontics And Dentofacial Orthopedics | 19234 (Massachusetts) | Primary |
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